Centene is the rare insurance company that really has made a fortune from Obamacare, to borrow President Donald Trump’s phrase. The ACA is only one factor in the company’s growth, but since Centene took its first wary steps into these marketplaces in 2014, its stock price has tripled, annual revenue has climbed from $10.9 billion to more than $40 billion, and net income has swelled more than threefold, despite thin margins. Chief Executive Officer Michael Neidorff last year was awarded $22 million in compensation, more than his peers at UnitedHealth Group, Aetna, and Humana. One of his biggest headaches these days is finding office space for all the people Centene has to hire to handle new business.

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A once-obscure company called Centene does it by limiting access to providers, focusing on its unhealthiest clients, and being the only game in town.