In 2025, seven insurers generated $1.7 trillion in revenue and $54 billion in profit while covering 10 million fewer people. Premiums hit $26,993 for families. Public funding expanded. Consolidation deepened. The incentive structure driving American health insurance stands exposed.

The new bipartisan proposal to separate insurers, PBMs, and providers targets the financial structure behind rising costs and denials. This piece explains how ownership concentration reshaped care, why regulation failed, and what structural separation could change for patients.