[pilom]

It's after the surgery that he would be un-insurable. Before the ACA, when he turned 19, the only possible way for him to get insurance would have been to get a job that offered health insurance because he wasn't allowed on his parents plan and he had a pre-exsiting condition so he wouldn't have been approved for private insurance. After the ACA, at 19, he could have stayed on his parent's plan, bought private insurance because the insurers couldn't discriminate based on the pre-existing condition or get a job that offered health insurance.