> insurance companies didn't try to negotiate down costs? The ACA forced insurance companies to pay out 80% of their revenues in care costs or refund premiums

> insurance companies didn't try to negotiate down costs? The ACA forced insurance companies to pay out 80% of their revenues in care costs or refund premiums or pay penalties. Said differently, under the current ACA rules, insurance companies have 0 incentive to negotiate costs down. They won't get any return on that effort. It's less effort denying claims and narrowing networks so as to ration access naturally.