The youngest-ever female Fortune 500 CEO is reinventing the largest Medicaid insurer amid funding cuts and rising costs

In today’s CEO Daily: Diane Brady profiles Centene CEO Sarah London.

The big leadership story: CFOs plan AI-related layoffs—but not as many as you might think.

The markets: Up globally on reports of an Iran breakthrough

Plus: All the news and watercooler chat from Fortune.

Good morning. Sarah London, the youngest-ever female CEO to run a Fortune 500 company, isn’t leading from a place of comfort. As federal cuts and new regulations reshape U.S. health care, the chief executive of Centene, the country’s biggest Medicaid insurer, is redefining what it means to innovate in a constrained environment. Her playbook is less about bold spending and more about disciplined reinvention; she’s streamlining operations, shedding noncore businesses, and using predictive algorithms to help manage care for vulnerable populations. At a moment when “the country is getting poorer and sicker,” as she puts it, London’s version of innovation is all about using technology to keep the social safety net intact. (You can read my full story on her here.)

Centene grew revenue almost 20% last year amid drastic cuts to federal Medicaid spending that have inflicted pain on the bottom line and customers. That hasn’t stopped London from focusing on programs that tie affordable housing to health care or leveraging AI to identify and deliver a suite of services to members with high-risk pregnancies.

“There is an opportunity in this moment to innovate and deliver within the construct of these programs,” she told me. “We’re harnessing this moment to transform and simplify the organization, to lean into our mission and the levers that are going to fundamentally change how we power that mission.”

Companies that stand the test of time tend to draw on their strong foundation to lean into the future. They’re focused on what’s ahead without ignoring the value that comes with expertise, relationships and brand. Case in point: the pioneering giants on Fortune’s 2026 Most Innovative Companies list, out this morning. As many of you know, we’re holding a Fortune 500 Innovation Forum in Detroit on Nov. 16 and 17 to look at the next 250 years of American innovation. It’s part of a broader push to dig into the issues and opportunities around innovation, and to highlight the companies that are shaping what’s next. Get in touch with me or find out more here if you’re interested in joining us.Contact CEO Daily via Diane Brady at diane.brady@fortune.com

AI-related layoffs may not hit worst-case projections…

A National Bureau of Economic Research working paper surveyed 750 CFOs at U.S. firms and found fewer than half planned AI-related layoffs. That amounts to roughly 502,000 roles out of 125 million, nine times more than last year but far short of doomsday projections.

…but integration and training remains a priority

That said, training employees to use AI is top of mind for current corporate leadership. Fiverr CEO Micha Kaufman told Fortune that change starts at the top: “If you’re not practicing, don’t preach.”

Anthropic and DOW meet in court

Anthropic and the Department of War faced off in court Tuesday over the government's classification of the AI company as a national security supply-chain risk. District Judge Rita F. Lin expressed skepticism toward the government's case, suggesting Anthropic may be facing retaliation for publicly criticizing the Trump administration.

S&P 500 futures are up 0.84% this morning. The last session closed down 0.37%. The STOXX Europe 600 was up 1.37% in early trading. The U.K.’s FTSE 100 was up 1.08% in early trading. Japan’s Nikkei 225 was up 2.87%. China’s CSI 300 was up 1.4%. Hong Kong’s Hang Seng was up 1.09%. South Korea’s KOSPI was up 1.59%. India’s NIFTY 50 was up 1.72%. Bitcoin was steady at $71K.

Around the watercooler

Exclusive: Nevada legislators press Governor Lombardo on Boring Co. oversight, demanding plan for state’s ‘structural failures’ by Jessica Mathews

Perplexity CEO says AI layoffs aren’t so bad because people hate their jobs anyways: ‘That sort of glorious future is what we should look forward to’ by Sasha Rogelberg

Iran, the $39 trillion national debt and dedollarization: How Trump exposed America’s Achilles Heel in Hormuz by Nick Lichtenberg

Soaring fertilizer prices could pressure a U.S. agricultural industry that supports 50 million jobs and over $10 trillion in output by Tristan Bove

Tether announces it has brought on a Big Four firm to conduct long awaited audit by Carlos Garcia

CEO Daily is curated and edited by Joey Abrams, Claire Zillman and Lee Clifford.

Diane Brady writes about the issues and leaders impacting the global business landscape. In addition to writing Fortune’s CEO Daily newsletter, she co-hosts the Leadership Next podcast, interviews newsmakers on stage at events worldwide and oversees the Fortune CEO Initiative. She previously worked at Forbes, McKinsey, Bloomberg Businessweek, the Wall Street Journal, and Maclean's. Her book Fraternity was named one of Amazon’s best books of 2012, and she also co-wrote Connecting the Dots with former Cisco CEO John Chambers.

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