Over the past decade, the American health insurance industry has undergone a dramatic transformation, with the six largest for-profit insurers—Anthem, Centene, Cigna, CVS/Aetna, Humana, and UnitedHealth—experiencing an explosive increase in profits and revenues. This growth, largely driven by strategic mergers, acquisitions, and a shift towards government-funded programs, has reshaped the industry. When the Affordable Care Act (ACA) was enacted in 2010, it expanded access to health insurance, boosting the combined revenue of these companies from $245.2 billion in 2010 to over $1.1 trillion by 2021. During this period, profits more than tripled, soaring from $16.9 billion to $60.7 billion. While these financial gains reflect the insurers’ ability to capitalize on the ACA and broader healthcare trends, they also highlight growing concerns for consumers, who face rising premiums, deductibles, and out-of-pocket costs despite the industry’s unprecedented profitability .