ACA works on the premise that you can only afford to pay for sunk costs- people who cannot afford it outright, people who have preexisting conditions that aren't something benign like ringing ears- by requiring *everyone* pay for it. This of course includes people living hand to mouth who are perfectly healthy but still make enough money that they don't qualify for need based coverage. Of course there were other ways the system could fuck you over too- Obama effectively lied about being able to keep existing coverage, and there was zero promise that your new coverage would be anything like the old one in terms of quality. Plus, a lot of people working for small employers learned the hard way that this also meant their premiums exploded in cost.