It’s not useful to compare health insurance profit margins to other industries because the Federal Government requires that they spend 80% of all premium revenue on care. This is effectively a cap on profits and also creates an incentive for insurance companies to pay higher costs for care so they can make more profit.

Quite a few mutual insurance providers are struggling in places like California and Florida because they didn’t correctly price in the potential impacts of climate change. The main issue that mutual providers have is that their risk pools are much smaller and generally very regional. If your whole region is on fire then everyone is screwed.

Additionally, they are dependent on the same reinsurance providers that other for profit insurance providers are which is already more expensive for them because of the smaller risk pool.