Is your impression that insurance companies weren’t killing people for profit before the ACA came along?

It was much worse. Michael Moore did a darkly comic piece about a man who was guaranteed to die without treatment, whose insurance company was denying him treatment, and they showed up at the insurance company’s corporate office with him in tow and performed a funeral for him there. They eventually approved his coverage. But they had to work for years and years before they were able to recover the killing-people-on-purpose abilities that they had before the ACA became law, and they’re still missing some of them. They used to straight-up kick you off your health insurance if you got sick in a way that was going to be expensive for them to treat, for example. Now at least they have to be more subtle about it.