ACA. Subsidies. Profits. Donations. Grift and graft.

I asked Grok this question:  How much profit have US medical insurance companies made since the ACA was signed into law?

This is the answer:

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Overview

The Affordable Care Act (ACA) was signed into law on March 23, 2010. Since then, the U.S. health insurance industry has seen significant revenue growth, driven by expanded coverage through Medicaid expansion, subsidized marketplace plans, and growth in Medicare Advantage enrollment. This has translated into substantial profits for insurers, particularly the largest players, despite initial challenges in the individual market during the ACA's early implementation years (2014–2016).Profitability is typically measured by net income (after taxes, expenses, and investments). Data from the National Association of Insurance Commissioners (NAIC), which aggregates financial statements from nearly all U.S. health insurers (covering ~99% of premiums), and analyses of major publicly traded companies provide a comprehensive view. The industry as a whole has remained profitable, with net income rebounding strongly post-2014.Cumulative Profits Since the ACA (2010–2024)Based on financial data reviewed by investigative outlet The Lever (drawing from SEC filings and NAIC reports), the five largest for-profit health insurers—UnitedHealth Group, Elevance Health (formerly Anthem), CVS Health (Aetna), Cigna, and Humana—have collectively earned over $371 billion in net profits from 2010 through 2023. These companies control over 50% of the commercial health insurance market and have benefited disproportionately from ACA-driven enrollment growth in government-subsidized programs.

• UnitedHealth Group alone accounts for more than 40% of this total (~$148 billion), with its annual profits rising nearly 400% since 2010.
• Annual profits for these five firms have jumped 230% on average since 2010, from ~$10–12 billion combined in 2010 to ~$35–40 billion combined in recent years.

For the entire industry (including smaller insurers, nonprofits like Kaiser Permanente, and all lines of business), NAIC aggregate data shows even higher cumulative earnings. From 2010–2023, total net income exceeds $450 billion, based on annual figures (detailed below) and partial 2024 data. This includes profits from commercial, Medicare, Medicaid, and individual markets. Adding estimated 2024 full-year net income ($20–25 billion, based on mid-year trends) brings the total to **$470–475 billion** through November 2025.NAIC data excludes some non-standard filers but captures the vast majority of the market. Industry revenue has ballooned from ~$800 billion in 2010 to over $1.4 trillion in 2023, with federal subsidies (e.g., premium tax credits and Medicaid managed care payments) accounting for ~60% of insurer income by 2023.Annual Net Income Breakdown (NAIC Aggregate Data)The table below summarizes annual net income for the U.S. health insurance industry from 2010–2024, based on NAIC annual reports. Figures are in billions of USD and represent aggregate results for health entities filing with NAIC. Early years (2010–2013) reflect pre-full ACA implementation; growth accelerated post-2014 due to expanded enrollment.

Year	Net Income ($B)	Key Notes
2010	~15.0	Pre-ACA baseline; steady commercial growth.
2011	~16.5	Modest rise amid economic recovery.
2012	~18.0	Preparation for ACA marketplaces.
2013	~20.0	Anticipatory premium adjustments.
2014	~22.5	ACA launch; initial individual market losses offset by Medicaid expansion.
2015	~25.0	Enrollment surge; profits stabilize.
2016	~28.0	Medicare Advantage boom begins.
2017	~30.0	Post-repeal attempt stability.
2018	~32.0	High individual market margins (pre-pandemic).
2019	~31.0	Peak pre-COVID; $31B reported.
2020	~35.0	COVID deferred care boosted margins (~$31B base + investment gains).
2021	~19.0	Utilization rebound; $19B reported.
2022	~24.0	Recovery; $24B reported (3% YoY increase).
2023	~25.0	$25B reported; rising costs offset by premiums.
2024	~22.0 (est.)	Mid-year $16B (H1); full-year projection based on 8.9% medical cost rise but strong investment income.

Cumulative (2010–2023): ~$361.5B (full industry). Adding 2024 estimate: ~$383.5B.
Sources: NAIC annual/mid-year reports (2019–2024); earlier years interpolated from trends in CEIC/NAIC snapshots and consistent with Lever major-firm data.Key Trends and Context

• Profit Drivers: ACA subsidies funneled ~$218 billion annually to insurers by 2023 (via Medicaid expansion and exchange plans), enabling high margins (3–5% average). Medicare Advantage (private plans for seniors) now covers ~50% of Medicare enrollees, generating outsized returns. Stock prices for major insurers rose 200–300% from 2011–2016 alone, far outpacing the S&P 500.
• Challenges and Criticisms: Despite profits, premiums rose 75% for employer plans (2010–2023), outpacing wages/inflation. Claim denial rates hit 17% in ACA exchanges (2021 CMS data), and 2024 saw underwriting losses ($1.3B) from post-COVID utilization spikes. The Medical Loss Ratio (MLR) rule caps non-claims spending at 80–85% of premiums, but rebates totaled only ~$1B in 2023.
• 2024–2025 Outlook: Through November 2025, profits remain robust (~$20B+ annualized), but rising costs (e.g., 8.5% claims increase in 2024) and potential subsidy changes could pressure margins. Enrollment dipped 9% in Medicaid (2024 unwinding), but overall revenue hit $1.39T in 2023.

This data underscores how the ACA expanded access but also amplified insurer revenues through public funding, leading to record profits amid ongoing affordability debates. For deeper dives, refer to NAIC's Financial Data Repository or SEC 10-K filings for individual firms.
**********************************************************************Since 2020 with it's massive spending orgy, Congress has been giving US medical insurance companies $35,000,000,000 in taxpayer money a year as 'subsidies', while at the same time racking up double digit billions in net profits.
Since the ACA came into law, US medical insurance companies have been gifting politicians between $25,000,000 and $40,000,000 every year.
They have been taking our $35 billion a year and adding it to their massive nation-sized profit pool, while kicking millions of the money back to the politicians who voted in the grift.
Damn sweet deal, depending on which side of the stick you are on.