> There was no incentive before ACA to control prices either. Sure there was. Profit = revenue - costs. Previously, lowering costs - particularly claims - was

> There was no incentive before ACA to control prices either. Sure there was. Profit = revenue - costs. Previously, lowering costs - particularly claims - was a direct way to improve profits. Now, the formula is more complicated, because 80% of costs must be spent on claims. Lowering claims directly reduces the maximum amount of profit you can make. There's still an incentive to reduce non-medical costs, but there's an incentive to increase medical costs, or shift non-medical costs to medical costs, in order to satisfy the 80% rule.