In the summer of 2015, Andy Slavitt didn't have time for maybes.
Slavitt, then-administrator for the Centers for Medicare and Medicaid Services, had spent all year working to shore up the Affordable Care Act exchanges after many of the major insurers withdrew, saying that the marketplaces were too risky. But Arizona's Maricopa County posed a problem. The largest county in the state and fourth-largest county in the country had no ACA insurance options just weeks before open enrollment.
Slavitt called the heads of several insurers, begging them to launch a plan in Maricopa, with each CEO saying they would study the area to see if it made financial sense.
Then Centene Corp. Chairman and CEO Michael Neidorff agreed to offer a plan sight unseen, Slavitt said.
"I thought about the fact that, when you're in government, people say to you, 'Hey, if you need anything, just let me know,' and how few people really mean it. This was the power of Michael," Slavitt said.
Two years later, late Sen. John McCain (R-Ariz.) cast the deciding vote that prevented Republicans from repealing Obamacare, a move Slavitt doesn't think would have happened without the Centene ACA offering.
"Michael was one of a very small number of people responsible for saving the ACA," he said
Neidorff, 79, died on Thursday after suffering what his family described as a lengthy illness. He served as the head of St. Louis-based Centene for more than a quarter of a century before announcing a plan to retire at the end of this year. His fusion of his personal values with his professional life will define his legacy, policymakers and health insurance leaders said.
"Michael's gift was in the giving," Slavitt said. "All he wanted to do was contribute."
In 1996, Neidorff joined Centene, assuming leadership of the single health plan that covered three counties. Over the years, he focused on growing Centene through acquisition, with the companies' largest recent deal being its $15 billion merger with rival government insurer WellCare. At the time of the transaction, Centene captured headlines for investing in an ACA plan as the Supreme Court decision over whether to end the program loomed.
"We have to look at the practical, the political," Neidorff told Health Leaders at the time. "Everything I saw said, 'This is a great transaction. It puts two great companies tougher in a very meaningful way, serving a lot of audiences that you can never do enough to serve.'"
Centene grew the fastest compared with its seven publicly traded rivals in the past decade, a Moody's Investors Service report said last summer. The insurer is now a $125 billion, Fortune 25 company and the largest Medicaid carrier in the nation, with lower-income adults and children making up more than half of its 26.6 million enrollees. The company also is a major player in the Medicare Advantage and ACA exchanges business.
The insurer's public health footprint is no accident.
Neidorff was a tireless advocate for improving the health of underrepresented and underserved communities, and an industry leader in recognizing and investing in behavioral health tools and social determinants services to grow individuals' wellbeing, health insurance lobbying group AHIP CEO Matt Eyles said in a statement. Neidorff served as a member of AHIP's board of directors.
"It was that vision that grew Centene from a regional business to one of the nation's leading health insurance providers," Eyles said in a statement.
The heads of other large ACA and Medicaid insurers likewise called Neidorff a leader in transforming care for the most vulnerable, with Anthem CEO Gail Boudreaux highlighting his unwavering commitment to lift up communities in need. CVS Health CEO Karen Lynch noted his passion for increasing healthcare access and Molina Healthcare CEO Joe Zubretsky said he will miss Neidorff's energy and competitive spirit.
"The business we are in requires compassion, intellect and a sense of community, all qualities which Michael fully embodied," Zubretsky wrote in an email. "His steadfast leadership of Centene over two decades charted the course for those that carry on that mantle."
Neidorff's passion for bridging disparities led him to advocacy.
In the weeks following the civil unrest in Ferguson, Missouri in 2014, Neidorff spearheaded a $30 million investment in the community, "bringing much needed opportunity and hope to the region and anchoring small businesses in the community," an obituary written by the family said.
In 2016, he opened a $25 million call center office in Ferguson that included a preschool for employees' children. The company also donated more than $1 million to open a health clinic in the East St. Louis community.
His activism affected other communities as well. Neidorff assumed chairmanship of the board of trustees for the National Urban League in 2014, after serving on the board for four years prior. Neidorff helped the civil rights group navigate its long recovery following the Great Recession, and was "the driving force" behind the Urban League's $242 million new headquarters in Harlem, New York, president and CEO Marc H. Morial said in a statement.
"Our community is forever changed because of his influence, and he will never be forgotten," Morial said.
In May 2020, after George Floyd's murder in police custody and the subsequent protests, Neidorff used his public position to advocate for social change. He opened Centene's June 2020 annual investor day, which normally focuses on financial performance, by saying "Black Lives Matter." He spoke for several minutes about racial issues, new internal company committees and external initiatives aimed at spurring conversations and studying health disparities.
The insurer also set a national example as the first large company to mandate COVID-19 vaccines for its 75,000 employees, Slavitt said.
"I called other employers and what I heard a lot of was, 'We'd love to do it, it's a great idea, but we have to be careful because of A reason, B reason, C reason,'" Slavitt said. "Once again, I called Michael, and he said absolutely."
Modern Healthcare has recognized Neidorff for several years as one the magazine's 100 Most Influential People in Healthcare for his work advancing diversity, equity and inclusion in the healthcare industry. In his obituary, his family called out his work promoting women, people of color, LGBTQ, veterans and people with disabilities at Centene.
Neidorff's celebration of individuals who are different from him can be seen in Centene's new CEO: Sarah London, 41, the youngest woman to lead any of the publicly traded insurers.
In an email, London said Neidorff was a visionary who transformed care delivery in the U.S.
"Michael's passion lives within the women and men of Centene, and his commitment to the mission of transforming the health of America's most vulnerable citizens lives on," London said.