> If I can only make 10% profit (or whatever the law is), what is my incentive to keep healthcare costs down? The ONLY way I can grow my income if it healthcare

> If I can only make 10% profit (or whatever the law is), what is my incentive to keep healthcare costs down? The ONLY way I can grow my income if it healthcare costs go up. You're missing the step where you also have to increase premiums, i.e. price. And what normally keeps any seller from increasing their prices whenever they want is competition--some other insurer will get your business. That begs the question of how competitive the insurance market is. Let's assume it's woefully uncompetitive. But in that case I don't see how the ACA 80/20 rule on administrative overhead changes incentives and the evolution of price inflation one way or another. At best it temporarily disrupted existing inflationary schemes, at worst it does nothing.