[Brybry]

Before ACA you could be denied health insurance or coverage due to pre-existing conditions (or they could charge you so much that it was infeasible to get insurance).

This was huge because if you ever lost insurance and got new insurance (switched jobs) then you were often screwed.

ACA defined essential benefits. Before ACA insurance usually didn't cover things mental healthcare. Required coverage of preventative care/screenings/reproductive care for women.

Annual and lifetime coverage limits were banned. Your health insurance could no longer drop you because you got an expensive to treat cancer.

The amount of desperately needed consumer protections ACA added were immense.

Sure there are problems with ACA, especially the marketplace part of it, but overall it was a big change to healthcare in the US.

[amluto]

> Sure there are problems with ACA

That’s putting it mildly. Sure, the ACA was, in many respects, a big improvement over what came before it. But it’s still outrageously broken. Let’s consider the perspective of a person who wants health insurance:

1. You mostly want to be insured via your employer, and you mostly get screwed if you leave your job. The financial disincentives to insuring yourself are huge unless you qualify for the subsidies.

2. For some bizarre reason, you can use only buy insurance at some times of the year.

3. You more or less have to buy insurance through a website that is massively and incomprehensibly bad. Want to figure out what that insurance covers? It’s sort of doable, but it sure isn’t easy.

4. Whether or not you will get to fill a given prescription still seems arbitrary and vaguely malicious.

5. The whole system rubs the insane list prices of healthcare in your face, almost continuously. For drugs, even small amounts of Internet searching points out how much cheaper they are basically anywhere else.

It’s really hard to be excited about the ACA.

(For added fun, and this isn’t really the ACA’s fault but it sure is a failure of affordability and sure seems like a massive failure of government: check out hims.com. Pulling a random example, “generic for Cialis” is at least 3x the price on hims.com as it is via GoodRx.)

[prewett]

And if you are relatively healthy and able to pay your regular doctor bills out of pocket, ACA made catastrophic insurance illegal (because of the minimum requirements). It's sort of like making car insurance require $50 copays to the mechanic. Sure, it's nice if you need an engine rebuild, but paying for all that makes the insurance a lot more expensive if you have a reliable car. There's no need for me to pay the doctor's bill and the insurance company's profit+overhead, I'd like to have the option to pay normal stuff myself and only insure something too large for me to pay.

[jampekka]

If healthy people could opt out of insurance, it would get really expensive for the not-so-healthy. That's why mandatory insurances are quite common.

Wheter it's a good idea to do this via private for-profit insurance and healthcare is another question. I prefer to just pay it via taxes.

[nradov]

This might not be quite what you want, but the ACA does allow for High Deductible Health Plans (HDHP). Those have consumers paying out of pocket for normal stuff, using a Health Savings Account (HSA).

https://www.healthcare.gov/glossary/high-deductible-health-p...

[amluto]

Which are, nonetheless, rather impressively worse in basically all respects than the old medically underwritten individual plans. Other than the fact that anyone can get them, of course.

I’m not saying that the ACA was a bad law. I’m saying that a not-so-nerdy voter contemplating whether ACA is a great achievement of the Democratic Party is likely to be unimpressed.

[nradov]

Worse in some ways, better in others. The old individual plans usually had serious limits on coverage of pre-existing conditions. And they had lifetime coverage limits which could be exhausted by a single serious illness or injury.

[jjav]

> It’s really hard to be excited about the ACA.

While your complains are all true and the ACA is a mess compared to any developed country, it is still very exciting to have the ACA. For anyone who was barred from getting insurance before, it is the lifesaver, literally.

Compared to other countries, ACA isn't very good (to put it mildly) but compared to how the US was before it, it is the most wonderful improvement ever.

[lokar]

Re: 2

You can use a broker (free to you) and get the same (regulated) plans. If your situation is at all complicated you should definitely use one. Probably even for “simple “ cases.