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Expand chart
Data: Company documents; Chart: Will Chase/Axios

UnitedHealth Group isn't just making more money because people deferred care throughout the coronavirus pandemic. It's making more money because it's owning a bigger piece of the health care system.

The bottom line: Insurers keep more of the premiums they collect when they also own the medical providers that are paid those premium dollars. And no insurer has expanded as aggressively into care delivery over the years as UnitedHealth.

Zoom in: Each quarter, UnitedHealth reports what it calls "intercompany eliminations."

  • This is when money transfers from one part of the company to another. UnitedHealth can't record the transaction as revenue because it is just paying itself.
  • For example, if a worker with UnitedHealthcare insurance goes to a surgery center or physician practice owned by Optum? That's an intercompany elimination. A 70-year-old with a UnitedHealthcare Medicare Advantage plan fills a prescription through Optum's specialty pharmacy? That's one, too.

By the numbers: UnitedHealth recorded $43.8 billion of eliminations in the first half of 2021, putting it on pace for roughly $91 billion for the entire year.

  • That amount would be four times as much as the eliminations UnitedHealth recorded a decade ago.

The big picture: Federal law caps health insurance profits to 15-20% of collected premiums, depending on the type of market.

  • But there are no limits to how much profit a provider can keep. So if an insurer can steer its members toward its own providers, the company is able to keep a lot more of those premium dollars.
  • It's no surprise, then, that other insurers like Bright Health are mimicking what UnitedHealth has been doing.

Go deeper

Aug 10, 2021 - Health

Democrats' high-stakes fight against pharma

Illustration: Sarah Grillo/Axios

Democrats' proposed expansions to health coverage and other patient-friendly policies released Monday are reliant on successfully taking on one of Washington's most powerful industries: pharmaceutical companies.

Between the lines: The way Democrats have set up their reconciliation package likely forces them to pass significant prescription drug pricing reform if they want to also pass other measures designed to make health care more affordable — a key selling point for the entire package.

Updated 48 mins ago - World

State Department orders evacuation of U.S. diplomats' families from Ukraine

From left, Under Secretary for Political Affairs Victoria Nuland, Secretary of State Antony Blinken and U.S. Chargés d'Affaires in Ukraine Kristina Kvien during a meeting with Prime Minister of Ukraine Denys Shmyhal in Kyiv. Photo: Yevhen Liubimov/ Ukrinform/Barcroft Media via Getty Images

The State Department will begin evacuating families and non-essential staff from the U.S. Embassy in Kyiv this week, according to a travel advisory published Sunday evening.

Why it matters: The move underscores U.S. fears that a Russian invasion could destabilize Ukraine and threaten embassy's ability to assist Americans.

Perfect storm brewing for extreme politicians

Data: Axios research; Table: Jacque Schrag/Axios

Redistricting and a flood of departing incumbents are paving the way for more extreme candidates in this year's midterm elections.

Driving the news: At least 19 House districts in 12 states are primed to attract such candidates — hard partisans running in strongly partisan districts — according to an Axios analysis of districts as measured by the Cook Political Report's Partisan Voter Index (PVI).

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