To add to this, before, insurance companies tried pushing care costs down and tried to keep premiums lower in order to compete with other insurers. Now with a m

To add to this, before, insurance companies tried pushing care costs down and tried to keep premiums lower in order to compete with other insurers. Now with a mandate for coverage the competitive pressure to keep premiums lower in order to steal customers away from others and induce new uncovered buyers went away. A silent industry wide "gentlemen's" agreement now exists. Don't compete on lower premiums, let health care costs go up so they all benefit. It's easier to allow costs to go up and profit more by passing costs onto customers than it is to compete on having lower premiums by reducing costs and being more efficient. You can only cut expenses so much, but the sky is the limit to profits if cost plus pricing is in play and costs go up for the entire industry.