In the past 12 years, the landscape of the American health insurance industry has shifted significantly, with the six largest insurers—Anthem, Centene, Cigna, CVS/Aetna, Humana, and UnitedHealth—moving away from private commercial health plans and increasingly focusing on government-funded programs. Between 2010 and 2021, commercial health plan enrollments grew only modestly from 84.9 million to 91.3 million, a mere 7.6% increase. In stark contrast, enrollments in government-funded programs such as Medicare Advantage, Medicaid, and Medicare supplement plans surged by 373%, rising from 16.9 million to 63 million. This shift was fueled by the ACA’s expansion of Medicaid and subsidies for private insurance, leading these insurers to rely heavily on public funds. Nearly 90% of their enrollment growth since 2010 has come from these taxpayer-funded sources, raising concerns about the long-term sustainability and fairness of the healthcare system, as more of their revenue now depends on public dollars rather than private premiums .