Nancy Pelosi’s 2010 Promise Aged Like Milk – We Found Out What Was in the Bill… $41 Billion in Insurance Profits

In the United States, health insurance is no longer a safety net—it's a business model. And like any business model, it's designed to extract, not protect. Over the past decade, the Affordable Care Act (ACA)—once hailed as a landmark reform—has quietly evolved into a subsidy machine for the very corporations that make health care unaffordable.

This isn't a glitch. It's the system working exactly as intended.

The Insurance Industry's Windfall

When the ACA passed in 2010, it mandated that Americans carry health insurance or face a penalty. Millions of new customers flooded the market, and the federal government stepped in with subsidies to help low-income individuals afford coverage. But those subsidies didn't go to the people—they went to the insurers.

Companies like UnitedHealth Group, Cigna, Anthem, and Centene saw their revenues explode. UnitedHealth alone grew from $110 billion in 2013 to over $370 billion by 2023. Stock prices soared. Executive bonuses ballooned. And the average American? Higher premiums, narrower networks, and deductibles so steep they couldn't afford to use the coverage they paid for.

The ACA's structure guaranteed profits. Insurers were required to spend 80% of premiums on care—but that left 20% for profit and overhead. On billions in premiums, that's a massive margin. And with millions of new enrollees, the math was simple: more customers = more public money = more shareholder returns.

Subsidies That Bypass the Patient

ACA subsidies are often described as "helping people afford insurance." In practice, they function as direct payments to insurance companies. The government pays part of your premium—sometimes most of it—but the money goes straight to the insurer. You never see it. You never touch it.

This creates a perverse incentive: insurers can raise premiums, knowing the government will cover the difference for low-income enrollees. And they did. Between 2010 and 2020, average premiums for benchmark ACA plans rose by over 100% in many states.

Meanwhile, deductibles climbed. Bronze plans—the cheapest tier—often come with $6,000+ deductibles. For many, it's insurance in name only.

Hospitals and Pharma: The Other Winners

Hospitals benefited from Medicaid expansion, which brought billions in reimbursements for previously uninsured patients. But they also continued to charge exorbitant rates—especially for out-of-network care. Surprise billing became a national crisis.

Pharma saw a surge in prescription volume. More insured patients meant more drugs sold. But the ACA did little to regulate drug prices. Result? Record profits for drug makers, unaffordable prescriptions for patients.

Executive Pay and Shareholder Gains

While Americans struggled, health care executives thrived.

• David Wichmann, former CEO of UnitedHealth, earned $52 million in 2020.

• Joseph Zubretsky, CEO of Molina Healthcare, took home $20 million in 2022.

• Shareholders received hundreds of billions in dividends and stock buybacks.

These payouts were funded, in part, by taxpayer subsidies.

The Myth of "Affordable" Care

Today, 41% of insured adults skipped or delayed care because they couldn't afford it—even with coverage. This isn't affordability. It's financial entrapment.

The 2025 Shutdown—Day 40 and Counting

The current government shutdown, now in its 40th day, was triggered in part by disputes over ACA subsidies. Republicans demanded cuts. Democrats fought to preserve them. On Day 38, both sides agreed to a 90-day extension with zero structural changes. Translation: another $38 billion to insurers, zero relief for patients. Same game, new quarter.

Who's Left Behind?

• 27+ million uninsured

• Millions more underinsured

• Small businesses crushed by rising costs

• Low-income families on Medicaid rollercoasters

"We Have to Pass It to See What's in It"

Nancy Pelosi, 2010. She wasn't wrong. We passed it. We saw. And what was in it was a pipeline of public money to private coffers.

Democrats had 15 years to fix it. They chose not to.

What Real Reform Looks Like

The current system isn’t broken—it’s predatory by design. Tweaking it won’t work. We have to rip out the profit engines and hand control back to patients and doctors. Here are the five moves that actually do it:

1. Break the Employer-Insurance Knot 

Tying your health coverage to your job is a 1940s tax dodge that became a national hostage situation. 

   Fix: Give every American the same tax break employers get. Let people buy portable, individual plans that follow them job to job, state to state. First step: Pass the “Health Freedom Act”—one page that ends the employer deduction unless the worker can take the exact same subsidy to the open market.

2. Kill the Middleman with Member-Owned Pools 

   Insurance companies are toll booths on the road to your doctor. Remove the toll. 

   Fix: Legalize large-scale, non-profit health cooperatives—think credit unions for healthcare. Neighbors, gig workers, veterans—100+ people form a pool, negotiate directly with providers, vote on benefits, keep surplus as lower premiums or cash rebates. No $50M CEOs. First step: Strip the “risk-bearing entity” red tape that makes this illegal in most states.

3. Separate Routine Care from Catastrophic Risk 

   You don’t use Geico for oil changes. Stop using “insurance” for check-ups. 

   Fix: Make Direct Primary Care + true catastrophic plans the default. Pay your doctor $75-150/month for unlimited visits, texts, generics—no prior auths. Buy cheap catastrophe coverage for the big stuff. First step: Expand HSAs to everyone—no high-deductible plan required, no caps, usable for DPC, dental, vision, medical tourism.

4. Force Price Transparency with Teeth 

   Hospitals hide prices like cartels hide stash houses. Shine a floodlight. 

   Fix: Require every facility to post cash prices online for every procedure, updated weekly, searchable format. Ban secret contracts. If an MRI is $400 at Clinic A and $3,200 two miles away, patients vote with their feet. First step: Make violation a felony with personal liability for the hospital CEO.

5. Open the Borders to Global Competition 

   Knee replacement in Thailand: $12,000 with beach view. Same outcome, 80% less. 

   Fix: Let any plan or HSA reimburse international care at 110% of Medicare rates. Streamline licensing for foreign-trained doctors. First step: Medicare pilot paying for joint replacements in Mexico or India—saves taxpayers billions overnight.

Bonus: Let states run the experiment 

Any state that cuts premiums 20%, halves the uninsured rate, and needs no bailout gets a full ACA/Medicaid waiver. Best model wins. Lobbyists lose.

The Bottom Line

Healthcare in America isn’t expensive because care is expensive. It’s expensive because we let middlemen build a casino on top of human suffering.

In 2023 alone, the five largest health insurers made $41 billion in profits—while 41% of insured Americans skipped care they needed.

Shut the casino down.