As anyone not locked in a closet knows the Affordable Care Act requires health insurers to spend 80 to 85% of premium dollars on claim payment (loss ratio) and at the same time requires closer scrutiny of requested premium increases with many states going one better in their zeal for denying premium increases.
Somehow we have redirected our focus from the problem to the symptom. In our quest to make health care “affordable” we are trying to make premiums alone affordable. Never the twain shall meet.
If you are an insurance company competing in a state with a dozen or more other insurers (at least one likely to be non-profit) you know you must compete on all fronts to attract and retain customers. The key to making money is volume not pricing, you need a lot of enrollees to make a little money on each contract and to give you leverage negotiating with health care providers. To get those customers you need competitive premiums, good customer service and a good network of providers. If either key element is missing, you will lose customers.
Our obsession with the operation of health insurance companies is unique among our purchases. How many Americans have or would like to have an iPhone and yet in evaluating their purchase is anyone concerned that the profit margin in each phone is between 60 and 75% depending on whose analysis you accept.
The problem with our short-term thinking about insurance premiums is that the process for setting premiums is based largely on estimating what will be spent on claims in the future. If premiums are kept articifially low in one year, they will have to be higher in future years to make up for the loss. The same holds true for the loss ratio. Forcing an insurer to provide a rebate because it failed to spend 85% of premium in one year gets us nowhere.
There are many elements within the Affordable Care Act that make us feel good, but divert our focus from dealing with the actual problems and in some cases actually increase costs.
QUINNSCOMMENTARY 
I doubt the MLR has anything to do with a desire to keep care/coverage affordable. It is like the jawboning we see from HHS when an insurer must raise rates more than 10%.
Much like the oil companies (where the margins are substantially less), this may be as much about picking the enemy and blaming someone for your problems/troubles.
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Right you are.
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