[albroland]

From the insurance side: I found the throwaway's reference of MLR very confusing and seems to be misinformed about the ACA market and MLR caps in particular.

Exchange plans are just about the most price sensitive insurance product I can think of; in ACA markets typically the lowest premium plan will capture the overwhelming majority of the signups. Insurance co's are highly incentivized to optimize their MLR to provide the maximum amount of care up to the rebate threshold, while driving costs down as much as possible to ensure you can offer the lowest premium plan on the exchange and be the take-all winner.

Also, so much of prior auth, step therapy, etc are dictated by federal or state regulations and not necessarily what the insurer would like or prefer to do.

There are plenty of pain points in our insurance industry but to carte blanche blame "for profit" companies seems really lazy.