UnitedHealth Group (NYSE:UNH) has been through some challenging times over the past several years. With politicians in Washington searching for ways to make healthcare more affordable for average Americans, many investors have feared that the health insurance giant could end up facing costly new regulations that would eat into its profits. So far, though, UnitedHealth has navigated the changing regulatory landscape well, while still trying to capitalize on growth opportunities along the way.

Coming into Tuesday's fourth-quarter financial report, UnitedHealth investors believed that the company would continue to perform well, and the numbers UnitedHealth posted largely lived up to those expectations. Even with the 2020 presidential election set to revive past debates about the healthcare sector, UnitedHealth has an ambitious agenda to keep itself moving in the right direction.

How UnitedHealth keeps on growing

UnitedHealth's fourth-quarter results were consistent with the company's track record of steady success. Sales climbed 4% to $60.9 billion, which was only a little bit shy of what most investors had expected. Net income attributable to shareholders picked up 16% to $3.54 billion, and the resulting adjusted earnings of $3.90 per share was $0.12 better than the consensus forecast among those following the stock. For the full year, revenue of $242.2 billion was up 7% from 2018's levels, and adjusted earnings of $15.11 per share picked up 17% year over year.

A stethoscope, pen, and calculator sitting on top of an explanation of insurance benefits form

Image source: Getty Images.

Looking at the company's two main segments, the UnitedHealthcare insurance business kept posting solid results, with segment revenue climbing 4% on a 15% jump in operating income. Within the business, UnitedHealthcare's Medicare and retirement unit saw the strongest growth, with the employer and individual division also seeing strong performance. Weakness in the company's global business held UnitedHealth back, as did declines in the community and state division. UnitedHealthcare picked up 845,000 more commercial customers in the employer and individual business along with 325,000 new Medicare Advantage policyholders.

Meanwhile, the Optum health services business saw stronger top-line growth. Sales jumped 8%, and operating income was higher by 12% year over year, driven largely by gains from the OptumHealth wellness and health management services division. The smaller OptumInsight data analytics business saw even faster 14% growth in its sales, but the OptumRx pharmacy benefit business saw its top line rise by less than 1% to hold back the Optum segment's overall performance.

What's ahead at UnitedHealth?

CEO David Wichmann homed in on his company's efforts to match up with what many politicians are looking for. "The dedicated women and men of UnitedHealth Group work together each day to improve outcomes and the patient and physician experience," Wichmann said, "while making healthcare more affordable, enabling us to serve more people better." The CEO also predicted more growth for 2020.

UnitedHealth specifically believes it'll be able to deliver more bottom-line gains for shareholders in the coming year. The healthcare giant repeated its recent guidance for the full 2020 year, including calls for adjusted earnings to be between $16.25 and $16.55 per share. That'd be around 8% to 10% higher than 2019's final number, and although that'd be a marked slowdown from the rate of growth in 2019, it would still keep UnitedHealth on an upward trajectory.

Yet there are still regulatory threats to UnitedHealth's business. The Supreme Court will likely review a case that looks at the rights of state governments to regulate pharmacy benefit managers and the amounts they reimburse pharmacies for prescription drugs. If state regulators have the ability to limit the markups PBMs can charge, it could put UnitedHealth on the defensive in justifying its practices.

UnitedHealth's investors seemed generally pleased by the report, acknowledging that growth might slow going into 2020. Shareholders appear comfortable with how the healthcare company is handling a volatile situation in Washington, but they'll be keeping a close eye on things to make aren't surprised by anything unexpected in the future.