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[–] AncientArachnid 0 points 3 points 3 points (+3|-0) ago (edited ago)
First off -- the number of people who initially actually needed to buy coverage in the exchanges was, relative to the entire US population, fairly small and should have remained so (I'll come back to that in a minute).
The vast majority of people in the US were covered by an employer's plan, Medicare (65+), or Medicaid (very low income, seniors unable to afford Medicare's small premiums, or those with dependent children).
Obamacare was intended to ensure that people who were not covered by an employer and who did not qualify for Medicare or Medicaid would at least have a hope of a prayer of a chance to access a doctor if they needed one. That imo as a civilized nation is not a bad thing.
The biggest problem was not the individual mandate, although that got a lot of attention (and rightfully so). The biggest problem was the employer mandate that employers with 50 or more employees were required to offer "adequate" coverage to their employees.
What this did was skew and warp our entire employment market, made even worse by the worst recession since the Great Depression. If you were a small business owner, you did everything in your power to cap at 49 employees. People who formerly held 40-hour-a-week jobs were made independent contractors; people's hours were cut to part-time; full-time jobs were cut in two to make two 20-hour-a-week jobs to prevent having to offer insurance. The "gig economy" was already well on its way before the ACA was passed, but the ACA dramatically accelerated it.
So now, all those folks who had been covered by employers, or who might have been able to find full-time benefited work, no longer could and they were forced onto the exchanges, swelling the numbers of those who originally truly needed some way of accessing health care.
Understandably many younger people opted not to buy. This skewed the pool toward older and sicker people, which in turn raises costs, which in turn raises rates => "death spiral". In the meantime, legitimately self-employed people who had been purchasing decent single coverage on the private market saw premiums rise dramatically and unaffordably.
The core issue is not health insurance, coverage, premiums or anything else. The core issue is costs. Health insurance should be available at a reasonable cost for catastrophic events. That's what insurance is.
Health care should be something for which most normal people can pay for the basics themselves. When the cost of simply seeing a doctor for strep throat, a few stitches for a cut, having a mole removed, etc. becomes stratospheric, then people can't take care of even the basic needs themselves. That, though, is a different discussion for a different thread.
Tl;dr: way more people ended up "needing" Obamacare because of how Obamacare twisted the employment market. Catch-22.