Sarah London operates on the front lines of the toughest terrain in U.S. health care. She’s the CEO of Centene, an insurance giant providing government-sponsored plans at a time when funding is tight, costs are rising, and policy shifts create intense uncertainty.
While the St. Louis–based managed care insurer saw revenue grow almost 20% last year, to $194.8 billion, it posted a net loss of $6.7 billion. That was largely driven by a write-down that reflected the new reality for health care companies under the One Big Beautiful Bill Act championed by President Trump. Along with cutting federal Medicaid spending by more than $900 billion over 10 years, the law raises costs and reduces eligibility for people enrolled in Affordable Care Act (ACA) Marketplace plans.
