Let me start this diary by enumerating some things that I am not:
Poor.
Uninsured.
However, I am:
Retired, but under 65.
My husband and I live in Mexico most of the year. When we left our jobs, we went on COBRA. It was expensive, but the coverage, through my husband's former employer, was pretty darn good. However, we knew that it would only last 18 months.
We'd researched our post-COBRA options, and thought we were covered. My husband was able to buy an affordable ex-pat policy. Since medical costs are so much lower out of the US than in it, these policies are quite inexpensive. Since medical care is quite good in Mexico, we're completely comfortable with this option.
For me, however, things were a bit trickier.
I have a rather severe case of Psoriatic Arthritis. The good news is that it's quite well controlled with a biologic drug. The bad news is that this drug costs thousands of dollars a month. Most of the ex-pat policies wouldn't touch me with a ten foot pole. The ones that would wanted to exclude anything that might be attributable to my arthritis. Since Psoriatic Arthritis is an autoimmune disease, that meant they wanted to exclude anything that had to do with my immune system, As you might imagine, that's a pretty broad exclusion. The only option available to me was a HIPAA policy.
HIPAA is a federal law enacted in 1996 that allows people to move from one group policy to another without a pre-existing condition waiting period if they haven't had a break in coverage of more than 62 days. It also allows someone like me who has exhausted their COBRA coverage to purchase an individual policy. Individual HIPAA eligible policies are very expensive (>$600/month), and have high out of pocket costs (think $5000 deductible, $12k annual out of pocket limit) but they do provide pretty comprehensive coverage after that. Honestly, given what it would cost me to get the care I need without insurance, in my case it's still a pretty good deal. Insurance companies don't advertise them (they don't want these customers), but they are available, if you know about them and look hard enough. The catch is that the right to purchase a HIPAA policy is a one shot deal. The policy you pick when you go off of COBRA is the one you're stuck with. That wouldn't seem so bad, but the insurance companies have figured out how to game the system. Every couple of years, they change the policy that's available through HIPAA. I can continue to buy the policy I originally signed up for, but new customers are buying something else. This means that as the people in "my" pool slowly become sicker and sicker, costs go up, and people who aren't desperate drop out of the pool, causing costs to go up even more. Not good.
The affordable care act means that I will be able to buy a policy - any available policy - through the new exchanges. It means I no longer have to worry about what will happen as the pool of insureds for my HIPAA policy gets smaller and sicker. It means I'm not shut out of moving to a policy that better fits my needs, should one become available. It will also cost less. Much less.
I have always recognized the absolute necessity of having health insurance. I literally have never been without it. When I graduated from college, I went on COBRA through my parents' policy until I had a job that provided health insurance. When I've been between jobs, I've paid for COBRA. For more than 30 years, long before I got sick, I paid, and paid, and paid for health coverage. I could afford it. I knew it was something I needed. Yet when I really needed to use it, it suddenly became very difficult, and extremely expensive, to obtain. The ACA removes that difficulty, and for many people, much of that expense. Health insurance will no longer be something that you are welcome to pay for until you actually need it. Now, everyone will be treated the same - both people who are sick, and people who have yet to become sick (because, let's face it, pretty much everyone is going to have something go wrong with them at some point in their lives). They'll all be able to get health insurance.
I realize that my situation isn't the most common one. For many people, the subsidies may be the most important aspect of the ACA. The elimination of lifetime and annual limits are another important feature. But to me, the fundamental thing about the ACA is that it makes health insurance available. Available to everyone. People won't need to face bankruptcy because of health issues. People won't need to suffer from a degenerative, treatable disease because an insurance company says it's a pre-existing condition. People won't need to die senselessly because they were afraid to get that "thing" looked at until that "thing" turned out to be metastatic cancer. Health insurance is transitioning from a privilege - something you can get if you're employed, if you're healthy, if you're rich, if you're old - to a right: something everyone can have, in many cases even if they can't pay for it, or can't pay the entire cost. And that is huge. Just huge.
If you think you don't need health insurance, if you think it's a government intrusion, if you think it's too expensive, too comprehensive, too something - get back to me when you, or someone you care about, gets sick or has an accident. Tell me how expensive it feels then, or how intrusive. Because I'm betting that you'll be damned glad that insurance you were "forced" to purchase is there, insulating you from the expenses that you never thought would happen to you.
It's not perfect, but it's a start.