The news: UnitedHealth Group will return Affordable Care Act (ACA) marketplace profits to consumers in 2026, according to CEO Stephen Hemsley.

Hemsley announced the plan in a prepared statement ahead of a Thursday congressional hearing where five “big health insurance” CEOs (the other four being from Elevance Health, CVS Health, Cigna, and Blue Shield parent company Ascendiun) were grilled by senators over insurers’ role in rising healthcare costs.

Unpacking the news: UnitedHealth is likely aiming to recoup some goodwill by refunding profits from its ACA plans, though the sums involved are probably too small to meaningfully affect its business practices or healthcare affordability. UnitedHealth doesn’t break out its ACA revenues, but it’s a smaller player in the market, with about 1 million members in ACA plans, per Politico—only about 2% of its total insured footprint.

Why it matters: UnitedHealth has become a focal point of public and private criticism, as US health insurers post billions in annual profits while exerting significant influence over patients’ medical decisions—even as medical costs rise and reports of delayed or denied care increase.

• UnitedHealth generated $34 billion in profits in 2024—the largest among the seven biggest publicly traded health insurers, which together earned more than $71 billion, per an August 2025 Health Care un-covered analysis. That’s an increase of over half a billion dollars from 2023.
• UnitedHealth denied about 33% of in-network claims for ACA plans in 2023, per a KFF analysis last year, which is the most recent available data. Insurers overall denied 19% of in-network ACA claims in 2023, up from 16% a year earlier.
• Three of the insurers testifying—UnitedHealth, CVS, and Cigna—are vertically integrated companies, owning pharmacy benefit managers that influence drug prices as well as medical groups.

Implications for health insurers: At the hearing, big health insurer CEOs blamed hospitals and drugmakers for rising costs, underscoring a familiar round of scapegoating that continues to crowd out real solutions.

Dozens of health plans have pledged to streamline prior authorization—a process linked to delayed and denied care—but like UnitedHealth’s ACA refunds, the effort lacks follow-up accountability to prove it reduces patients’ out-of-pocket costs.

Health insurers are not the only reason healthcare costs are rising, but US consumers want to see full transparency of profits across all business segments and explanations behind rising premiums, worsening coverage, and denial decisions made mid-surgery before changing their views.

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