What can be done to loosen card companies' grip on this? It has been a constant problem now for decades.
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The simple fact is, Visa/MC don't want to deal with porn because the number of chargebacks and fraud from porn purchases is significant and a huge outlier compared to most other charges. Their crusade against processing charges for adult material isn't about purity, it's simply business.
Fraud is likely more realistic of an issue, but that's probably an issue with games in general, not just adult titles.
There are already high-risk merchant accounts with higher fees and cash reserve requirements, but AFAIK companies like Valve aren't being given any options other than comply or be destroyed.