Health insurer Centene (CNC) is advancing on Wednesday after the Medicaid coverage provider announced Tuesday night a “highly accretive” acquisition of Fidelis Care for $3.75B. Fidelis Care is a health plan that offers affordable health insurance coverage in New York.

EXECUTING ON ACA EXCHANGES: As other healthcare insurers like Aetna (AET) and UnitedHealth (UNH) step back from the Affordable Care Act’s challenged insurance exchanges, Centene, which specializes in the state and federal Medicaid programs for less advantaged and underserved, continues to execute on the ACA’s public insurance exchange, even as President Trump warns of the imminent collapse of the ACA and its exchanges. As of June 30, the company almost doubled the number of its clients in plans purchases on ACA exchanges to 1.1M compared to 617,000 at the same time period in 2016.

EXPANDS TO NY WITH FIDELIS: In the Fidelis deal, Centene will now have a “leadership” position in New York, the country’s second largest managed care state by membership. The health insurer now will have a leadership position in the country’s four largest managed care states by membership — California, Florida, New York, and Texas. Fidelis Care is a not-for-profit corporation that is a diversified leader in government programs, serving over 1.6M members as of June 30. “We believe our over 30 years of experience, our local approach to the provision of healthcare, and our expertise and capabilities in caring for underserved populations will support the next generation of leadership in government programs in New York State,” said Michael F. Neidorff, Chairman, President and CEO of Centene. With the Fidelis acquisition, Centene expects to generate 2018 pro-forma total revenues of over $60B assuming a January 1, 2018 closing date. The transaction is expected to generate immediate accretion to year one GAAP earnings per share, high single-digit and low- to mid-teens percentage accretion to adjusted earnings per share in year one and year two, respectively. Centene expects to achieve $25M of pre-tax net synergies in year one and $100M run-rate synergies beginning in Year two. Synergies will come from areas primarily attributable to reduced medical costs through the use of Centene’s systems and medical management, said the company in a statement.