Seven of the nation’s largest healthcare corporations have avoided paying more than $34 billion in taxes since the enactment of the 2017 Trump-GOP tax law, according to a new report by Americans for Tax Fairness and Community Catalyst. At the same time, patients and workers have faced rising costs, higher claim denials, and declining standards of care.
The report found that average annual profits among Centene, Cigna, Elevance (formerly Anthem), Humana, CVS Health, HCA Healthcare, and Universal Health Services surged by 75 percent after the law, jumping from about $21 billion before 2017 to roughly $35 billion in the years following. Yet the amount they collectively paid in federal taxes stayed flat, reflecting the dramatic impact of the corporate rate cut from 35 percent to 21 percent.
“Seven of America’s biggest healthcare corporations have dodged over $34 billion in collective taxes since the enactment of the 2017 Trump-GOP tax law,” the report said. “Healthcare corporations failed to use their tax savings to lower costs for customers or meaningfully boost worker pay.”
Instead, the windfall was redirected to shareholders and executives. Stock buybacks rose by 42 percent, dividends more than doubled to an average of $5.6 billion a year, and top executives at the seven firms collectively enjoyed a 42 percent pay increase—about $100 million more in total. Median worker pay increased by just $14,000 over the same period, a rise of 24.8 percent.
One of the starkest examples is Centene, which saved $7.3 billion in taxes. After 2017, the company repurchased on average 20 times more of its own shares than in the years prior. “Centene on average repurchased 20 times more shares in the years following the enactment of the Trump-GOP tax law as it did in the four years preceding it,” the report noted. In 2024 alone, Centene spent more than $3 billion buying back its stock.
CVS Health also saved $7.3 billion under the law and directed much of that into shareholder dividends, which jumped by 75 percent. Despite more than doubling its profits in 2023 compared to the previous year, CVS “hired zero additional employees and actually cut its median annual wage by almost $900.”
Patients, meanwhile, have faced increasing barriers to care. Medicare Advantage insurers—Cigna, Centene, Elevance, and Humana—were found to have some of the highest rates of prior authorization denials. Appeals reveal that many of these denials were improper. At Centene, 93.6 percent of denials were overturned on appeal. Cigna’s rate was 86 percent, Elevance 71 percent, and Humana 65 percent.
“Denying prior authorizations is a good way of boosting corporate profits,” the report stated.
Cigna has been especially criticized for its ownership of EviCore, a company that markets itself to insurers as a tool to reduce costs by increasing denials. ProPublica reported that EviCore salespeople boasted of helping clients raise denials by 15 percent, while Cigna doctors used algorithms to reject hundreds of thousands of claims in seconds.
Hospitals have also come under scrutiny. HCA Healthcare avoided $5.6 billion in taxes but was the subject of a 2023 NBC News investigation that documented “roaches in the operating room, leaking ceilings, essentially unmonitored vital signs, overworked nurses, overcrowded emergency rooms, closed departments and other threats to patient health and safety.” The Centers for Medicare and Medicaid Services rated 70 percent of HCA’s Florida hospitals below average, with none receiving five stars.
Universal Health Services, which saved $463 million, has been repeatedly cited for abusive practices. A Senate Finance Committee report in 2024 documented “widespread physical and sexual abuse at residential treatment facilities,” including a case in which “a staff member at one UHS facility pouring scalding water on a non-verbal 16-year-old with developmental disabilities, causing second- and third-degree burns.”
The report also examined private equity’s role in the collapse of Prospect Medical Holdings, which filed for bankruptcy this year after its former owner Leonard Green & Partners extracted $658 million in dividends, including a $457 million payout in 2018, the first year of the Trump tax cuts. “As the partners were enjoying tax savings, the patients were suffering,” the report concluded.
Americans for Tax Fairness and Community Catalyst argue that these outcomes highlight systemic flaws in both the tax system and the healthcare industry. “Congress should demand both more in tax revenue and better patient care from these highly profitable corporations,” the groups said. “Healthcare corporation profitability should not come before quality of patient care. In healthcare more than almost any other industry, the search for ever higher earnings threatens the well-being and lives of the American people.”
To read the full report, click here.
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