The largest health insurers, including UnitedHealth Group, CVS Health, Cigna, Humana and Elevance Health, are expressing less interest in diversity, equity and inclusion strategies, and more worry about bad publicity and the Trump administration, based on what they’ve tucked into their 2024 annual reports.

Each year, publicly traded companies file the reports for investors with the Securities and Exchange Commission, filling the pages with dense details on finances, operations, leadership and risks. Much of the reports consist of boilerplate language, but the changes in substance and tone from one year to the next can reveal a company’s frame of mind, said Bill Mayew, a professor at Duke University’s Fuqua School of Business.

“There’s litigation risk to misreporting things in a 10-K,” Mayew said. “Their goal year-to-year is to try to make what they say match the underlying economics as tight as possible.”

A number of themes have emerged as insurers in the past month have filed their reports for 2024.

DE&I Deleted

Language about DE&I initiatives has either been watered down or deleted entirely.

The shift mirrors moves other major companies, including Amazon, Disney and Google, are taking in the wake of political pressure. Companies largely began announcing DE&I efforts following the 2020 murder of George Floyd and are now rolling back the initiatives.

“Topics come and go, emphasis comes and goes, and for sure some emphasis is tied to the administration,” Mayhew said.

President Donald Trump signed executive orders to end DE&I efforts in the federal government and to spur the private sector to act similarly. On Trump’s second day in office, Jan. 21, he signed an executive order directing federal officials “to encourage the private sector to end illegal discrimination and preferences, including DEI,” the order said. A federal judge last month temporarily blocked part’s of Trump’s anti-DE&I executive orders.

Some companies began walking back DE&I programs last year and others have announced changes since the election to align with Trump.

Centene, Humana and Cigna have deleted entire DE&I sections that were included in reports filed last year.

Centene deleted all references to “diverse” and “diversity.” Humana kept only one mention of the terms, which were included more than a dozen times in last year’s report. Humana also removed DE&I training from a list of learning and development benefits offered to employees.

A Humana spokesperson did not answer questions about how its DE&I strategy is changing or why it deleted the section. “We have long believed that an inclusive culture and diverse workforce can empower our organization to better connect with the millions of Americans that rely upon us to provide high-quality, affordable healthcare,” the company said in a statement.

In CVS Health’s 2023 annual report, a section titled “Diversity, Equity, Inclusion & Belonging” was renamed “Workforce Strategy” in the 2024 report and mentions of “diverse” and “diversity” were cut to one, from 10. A CVS Health spokesperson said the company has not made any changes to its DE&I policies but did not answer questions about why the company reframed the section.

“Our goal is to attract the most talented and qualified workforce in healthcare and to develop and retain a workforce to support and advance our strategic priorities,” a CVS spokesperson said. “We believe that our workforce strategy should be responsive to and reflect the broad and diverse communities whose health care needs we serve.”

Elevance Health also renamed the section “Inclusion & Diversity” in the 2023 report to “Culture, Engagement and Inclusion” in the 2024 report. It added details about business resource groups available to employees to connect with others and its associate recognition program to honor personal and career successes.

“Elevance Health continually evaluates our associate experience to ensure we’re creating a workplace that attracts talent and supports professional growth and retention. The language you see in this report, reflects this work,” a spokesperson said.

CVS Health, along with Elevance Health, cut statistics on the share of employees by gender and race, while Cigna and Alignment Health kept the metrics. Alignment Health’s approach to DE&I is not changing, a spokesperson said.

A sentence in UnitedHealth Group’s report last year said its compensation practices were evaluated by “gender, ethnicity and race.” For the current report, the phrase “performance, age, [and] experience” was added.

Centene, Cigna and UnitedHealth Group did not return requests for comment.

Negative Publicity as a Risk Factor

In previous years, some insurers broadly alluded to the risk of negative publicity that could result from how new laws and policies, among other actions, could affect their business. But now companies like Centene and Elevance Health are breaking negative publicity out as its own risk potentially hurting financial performance.

The added language in the risk factors section of annual reports comes as insurers face federal probes of their pharmacy benefit managers, providers express growing discontent with insurers’ administrative burdens, consumers speak out about personal struggles navigating the industry, and the biggest insurers’ continue reporting billions of dollars in profits and revenues.

UnitedHealth Group, which has been at the center of federal investigations and public backlash, particularly following the murder of UnitedHealthcare CEO Brian Thompson in December, revised a sentence from last year about how its business could be affected to add the phrase “if [its] reputation suffers harm.”

CVS Health, Cigna, Humana and Alignment Health discussed the risk of negative publicity in both their 2023 and 2024 reports and kept language mostly the same.

Elevance Health’s description of the risk cited reasons for potential backlash including prior authorization, premium increases and consolidation. The company declined to  comment on the addition.

Security concerns were front and center for Molina Healthcare.

“Recently the threat environment for senior healthcare executives has worsened considerably, and the need for appropriate security to combat such threats could distract or disrupt senior management from performing their job responsibilities,” the company wrote in its 2024 annual report. Molina Healthcare did not return a request for comment on the addition.

Trump Worries

Health insurers are giving investors hints into how a second Trump term could impact finances and steer their interests this year.

CVS Health cautioned that the new tariffs, which Trump is enacting, could spur higher costs and supply chain disruptions. The company also listed changes to regulations and consumer sentiment toward vaccines — an area where Health and Human Services Secretary Robert F. Kennedy Jr. has expressed skepticism — as a risk to its financial performance.

Cigna revised its environmental, social and governance section regarding its approach to promoting a healthy society and environment. “We also help to eliminate barriers to care and address other factors that contribute to health disparities,” and “we see an opportunity to positively impact the environment through ways we are advancing our business, including through our continued investment in virtual care,” are two sentences missing from the 2024 report.

(Editor’s note: This story, written by Lauren Berryman, originally ran in Modern Healthcare on March 3, 2025)