In 2022 and the fourth quarter, EBITDA growth was 12 percent among publicly traded payers, which is expected to decline to "mid-to-high single-digit growth" in 2023. The report cited lower COVID-19 costs, solid individual market performance, and suspended Medicaid redeterminations for why 2022 saw strong earnings growth. The lower 2023 estimate is based on redeterminations resuming in April and potentially slowed commercial earnings "if economic conditions remain soft." The risk of impactful policy changes is also low until at least 2024 because of the divided Congress. UnitedHealth Group was given a positive credit outlook, while Aetna, Cigna, Elevance Health, Humana, and Molina were all classified as stable. Centene is also stable but has a mixed outlook for 2023, according to Moody's.