> Well, the insurance companies should care I'm not sure they "should", at least from a financial standpoint. The ACA basically put a cap on insurance company

> Well, the insurance companies should care I'm not sure they "should", at least from a financial standpoint. The ACA basically put a cap on insurance company profits, as a percentage. It's not phrased quite that way, but it's the upshot (look up "medical loss ratio"). This is the worst provision I know of in the ACA, because it sounds like a nice idea, but if you think it through, it actually disincentivizes insurance companies from doing what they can to lower costs. It basically says that the maximum amount that insurance companies can keep is 20% of premiums (assuming no administrative cost or other overhead). Say the average cost per person is $4000 / year, so the average premium is $5000 / year; they're able to make a $1000 profit, or 20% of the premium. Now suppose the insurance company negotiates costs down to $3000 per year. Well, the maximum premium they can charge now is $3750, so they lose 25% of their profit. On the other hand, if they sit by and let costs skyrocket to $6000, they can raise premiums to $7500, and make $1500 in profit. Now, of course insurance companies also compete on their premiums, so in theory, they still have some incentive to negotiate lower costs. But it seems like that must be seriously mitigated by the profit cap. I'm not an expert on this by any means, so if someone who is wants to set me straight, I'd love to hear it. But I'm just very confused as to why this provision was thought to be a good idea.