A layoff in 2002, well before the Affordable Care Act, forced me into my first experience buying individual health insurance.
The Blue Shield PPO I ended up with cost $350/month with a modest deductible. I was a healthy 20-something with no medical complications or needs other than one tiny pre-existing condition — seasonal allergies. Yep, run-of-the-mill allergies to pollen and a Claritin prescription, because it was still a prescription at that time, tagged me as a “risk”. It wasn’t a big enough risk for Blue Shield to deny coverage, but it was enough to nearly double my premiums. Being self-employed I’m more than aware that health care costs have been rising rapidly, but people are missing that it was ALREADY skyrocketing 20 years ago! That’s why the ACA was created.
Many Americans don’t seem to realize how much worse things were before the ACA and how easy it was to be left stranded without coverage at any cost. Basic standards of care were not guaranteed, junk policies were common. Free annual wellness checkups were not included, even for children. Denials of entire policies as well as claims due to pre-existing conditions were rampant. It didn’t even have to be big ticket items like cancer or heart disease, anything from asthma to psoriasis to pregnancy could lock you out. You read that right, pregnancy was a pre-existing condition and care for both mother and baby could be refused. Policies included monetary caps on care, meaning if you had an expensive health condition you could use up your whole lifetime allowance and never receive a dime of coverage again. And the cherry on top — they could cancel you for any reason at any time.
For all those who want to tear down the ACA, I ask: Then what? There is nothing to go back to! The ACA didn’t create a market where health care is unaffordable and inaccessible, it already was. Republicans at the time didn’t allow the legislation to have more teeth, this was the best the Democrats could pass as Republicans fought tooth and nail against anything at all. And let’s not forget Senator Lieberman, who earned his infamous place in history as the single vote that blocked including a public option that might have made a bigger difference. The ACA pulled what levers exist within this system, including minimum standards to ensure plans provide reasonable care, universal participation to bring down costs by balancing the pool, and subsidies to bring down the impacts of premiums on citizens.
It’s true none of that was enough because it was, at best, a compromise. But all those who wish to claw it back have offered no solutions, no alternatives except making sick people pay more and lose access to health care. Even if there was a plan, removing the subsidies changes nothing except making it more unaffordable today before there is anything else in place.
Bringing down the cost of health care is what’s needed, and that can only be done by overhauling the entire system and taking it outside of corporate control. Voices on the left have been begging for a national solution for decades, but the political will isn’t there to reshape health care as we know it even though we all agree this isn’t working.
In the meantime, we suffer. For 2026, without subsidies, I expect to spend a little over $10,000 on premiums for only myself then have to clear a nearly $6,000 deductible. That’s $16,000 out of pocket before receiving care beyond an annual checkup and $10,000 gone even if I use zero care. If Republicans have their way and the ACA is dismantled, I won’t even get that basic visit without paying full freight first.
You can’t imagine my relief when ACA was passed — this made my future as a self-employed consultant possible. It guaranteed I could get care at all, cost be damned. I honestly don’t know what my future looks like now or how to financially prepare for a world where insurance rates are skyrocketing (and not only health care). With 20 more years of life under my belt, my medical record will show any number of minor injuries and diagnoses that could be weaponized against me. It’s genuinely scary.