As rising health care costs and inadequate insurance coverage leave one in three Americans saddled with medical debt, the nation’s top health insurers have dumped billions into enriching their executives and top shareholders through lucrative stock buybacks.

All in all, the country’s largest health insurers have invested over $120 billion into repurchasing their own shares since the passage of the Affordable Care Act in 2010. These include UnitedHealth Group; Cigna; Elevance Health, the parent company of Anthem Blue Cross Blue Shield; and CVS Health, which acquired Aetna in 2018.

Forty-four percent of buyback expenditures came from UnitedHealth Group, which covers more Americans than any other private health insurer. UnitedHealth has increased its annual share repurchasing program by 217 percent since 2010, dumping a whopping $54 billion into buybacks during that time.

These companies, along with Kaiser Permanente, a nonprofit health care organization, control over half of the commercial market share of the US health insurance industry. Since 2010, they’ve raked in a combined $9 trillion in revenue, netting more than $371 billion in profits.

Meanwhile, one in four Americans say they’ve avoided seeking health care in the past year because of the cost. Half of all US adults say they’d be unable to afford an unexpected $500 medical expense, and medical bills account for 40 percent of US bankruptcies.

Major insurers have abandoned patients for shareholder enrichment, according to former health insurance executive-turned-whistleblower Wendell Potter. “[Health insurers] corrupted the concept of managed care and turned it into something that has been really more of managing cost, but also depriving people of the care that they need,” said Potter.

Insurers “have figured out how to extract so much money out of what we spend as a nation on health care to reward their shareholders. There’s no other country in the world that has a system like this that enables middlemen to siphon off so much money from middle-class and working-class folks that need health care,” he added.

Last week’s assassination of Brian Thompson, the CEO of UnitedHealth Group’s insurance subsidiary UnitedHealthcare, has resulted in an outpouring of anger and frustration toward major health insurers. Nearly two in three Americans now say they believe health care should be the government’s responsibility, according to polling organization Gallup — the highest amount in a decade.

Stock repurchases, like dividends, deliver value to shareholders and overwhelmingly benefit top investors. Corporations can boost share value in a simple game of supply and demand by buying back massive quantities of their own stock from the open market.

Data shows buybacks soared after congressional Republicans and the Trump administration slashed corporations’ tax burden through the Tax Cuts and Jobs Act of 2017. Proponents of Donald Trump’s tax cuts argued that corporations would reinvest their savings into research and workers — but instead, buybacks exploded. Goldman Sachs estimates corporate buybacks increased 55 percent between 2017 and 2018 alone.

In recent years, top C-suites across the health care industry have authorized more spending on stock buybacks than on company research and development.

“The very people we rely on to make investments in the productive capabilities that will increase our shared prosperity are instead devoting most of their companies’ profits to uses that will increase their own prosperity — with unsurprising results,” argued University of Massachusetts economist Bill Lazonick, an expert on financialization, in a 2014 Harvard Business Review article.

Since then, corporate buybacks have only grown more common and are on track to surpass $1 trillion annually by 2025.

Executives who authorize large buyback programs are often the ones who stand to personally benefit the most as recipients of lucrative stock awards and options.

Financial disclosures from this spring reveal UnitedHealth Group CEO Andrew Witty owned more than 292,000 shares in the company’s stock, worth $156 million today. Witty took home $23 million in compensation last year, 352 times more than his median employee.

Thompson, the slain CEO of UnitedHealthcare, took home $10 million in salary and stock in 2023. Both men are among a group of UnitedHealth executives recently sued for securities fraud by pensioners who claim the officers dumped millions in stocks just months before a federal antitrust probe into their company went public.

Longtime Cigna CEO David Cordani, a public detractor of universal health care, has amassed over 1.2 million shares in the company’s stock — worth $364 million today, financial records from earlier this year show.

As of this February, Elevance Health CEO Gail Boudreaux — an industry veteran who’s also worked for Aetna and UnitedHealth — owned a massive stake in her current employer worth nearly $149 million today.

Since lawmakers passed the Affordable Care Act, top health insurers have, on average, doubled their annual buyback expenditures.

“The rich are getting richer, that’s the point. . . . And we as consumers are paying for [it],” said Lazonick earlier this year.

Meanwhile, families spent an average of 55 percent more on their health care premiums in 2020 than they did in 2010. On a per-person basis, health care spending by Americans with private insurance grew by 61 percent from 2008 to 2022.

In 2022, the United States spent $4.5 trillion on health care compared to $2.6 trillion in 2010. The Centers for Medicare & Medicaid Services, the federal agency that manages the country’s biggest public health care program, predicts health care spending will outpace gross domestic product growth over the next decade and grow to represent one-fifth of the US economy.