Health insurance premium revenue = medical loss ratio + operating costs + profit margin

Medical loss ratio is the money paid to healthcare providers. Operating costs end up being ~10%, across multiple publicly listed companies. This fact, plus 2% to 3% profit margins means any more cost reductions have to come from legislation, reduction in healthcare prices, or advances in automation.

https://www.oliverwyman.com/our-expertise/insights/2023/mar/...

https://www.kff.org/private-insurance/medical-loss-ratio-reb...