The ESRB should have a stronger stance on the issue, but they've been pretty lax. The most recent thing I found was them stating loot boxes would be specifically listed under in game purchases, backing April 2020. If the general consensus is that more restrictions are needed and the ESRB doesn't act, federal government is likely to step in. For example games that allow for gambling with real currency should be rated AO according to their guidleines. At best they could be no lower than T.