> they do creative things like "outsource" IT or HR to a separate company (with the executives as ovepaid board members)

Source?

I am seeing 10-K reports showing UHC, Anthem, CVS, Cigna, Humana, Molina, Centene, etc all with profit margins ~5% or less.

Is the claim that executives at one or more of these companies is attempting to bypass ACA regulations (and violating fiduciary duties to their own employer) by overpaying for services to outside entities that the aforementioned executives control?

Seems like a grand conspiracy theory.