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We are reiterating our Neutral recommendation on the shares of UnitedHealth Group Inc. (UNH - Analyst Report). Though we are bullish on the company’s long-term growth prospects, there remain certain headwinds, such as high unemployment, growing medical costs, and pressure from Health Care overhaul, which might keep the earnings under check in the near term.

UnitedHealth is one of the biggest and most diversified health insurers in the U.S. It holds a huge market share in the Medicare market, which is expected to boom in the coming years as million of Americans enter retirement. The company has made a number of acquisitions (most significant of which is the purchase of XL Health Corp.) to further strengthen its position in the MA market, resulting in long-term growth.

UnitedHealth’s health service business is an essential part of the company’s diversification strategy. Management is considering the expansion of the health service business to produce 30%–40% of operating income over the longer term and has been making acquisitions in the area. It believes the company is under-penetrated in the health service area and that investment in this field will reap benefits over the long term.

UnitedHealth is also expanding its business internationally. Its acquisition of Brazil-based Amil is sure to bolster its top-line growth in the emerging Latin American market.    It has made an agreement with Dubai-based Al Sagr National Insurance Co. to expand in the Middle East.  Geographical diversification features prominently in the company’s plan of action to overcome restrictions imposed by the Health Care Reform back in the U.S. Over time we expect more deals from the company, pertaining to its international expansion where it faces less competition.

Factors offsetting the positives include higher operating costs, higher utilization as well as low investment income.

UnitedHealth is witnessing increased operating costs due to high medical and operating cost pressures related to the Affordable Care Act and Mental Health Parity Act. The company will also face heightened expenses in complying with the federally mandated ICD-10 coding and HIPAA 5010 standards.

Though the company had experience low medical care over the past couple of years leading to reducing medical claim cost and increasing profits, management expects return to normalized medical utilization trends soon. This will however wipe out the extra earnings benefit the company had been enjoying so far.

Low interest rates, which will culminate in low investment income putting earnings under pressure, are still a major cause of concern.

The company’s peers, such as Aetna Inc. (AET - Analyst Report), CIGNA Corp. (CI - Analyst Report), WellPoint Inc. (WLP - Analyst Report), are also carrying long-term Neutral recommendation. The stock of UnitedHealth retains a Zacks #3 Rank, which translates into a short-term Hold rating.

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