Insurance companies generally have a loss ratio: a percentage of income from insurance policies they must pay out. In health insurance this percentage varies: it’s lower for individual plans, and higher for group plans. Most commonly it’s 80%.
If they pay out less, in many cases they have to return the difference to policy owners. (Not always though. Often with Medicaid, for example, this isn’t the case.)
This doesn’t mean that they have no reason to deny care, however. They want their health care costs as close to that bottom number as possible without going past it. If they spend, say, 83% rather than 80%, that will cost them billions. Denial of care is meant to get the margin as close to to loss ratio as possible.
This also means that the best way to increase gross profits (not the percentage, but gross) is to sell as much insurance as possible. Eighty percent of a 2X is more than 80% of X.
So the incentives align such that the best way to make money is to sell as much as possible, then deny the necessary amount of care to get as close to the loss ratio as possible.
It should not need to be pointed out that Americans, as a group, are a very sick people: lots of obesity and chronic illness and in this age of Covid, long Covid and the rise of illness caused by post-Covid, more and more denial of care will be required to hit numbers.
Insurance company profit ratios hardly move in percentage terms. But making more money is still better, and the more money they make in gross terms the larger executive salaries, bonuses and stock options can be.