You're leaving out all of us healthy Americans that do consulting, run our own small businesses, or participate in the "gig" economy who were buying overpriced private insurance before.

But I said healthy Americans, and you know full well you've got to be well past unhinged to break out on your own as a sole proprietor!

(This just to counteract my overly weighty response as sibling to this)

No they're not leaving this entire demographic out. After all, the original article is anecdotes from entrepreneurs. They're saying that ACA subscribers in general are higher risk. That's not surprising considering that most poor people would shop for health insurance on the exchanges and poor people in general have worse health than rich people.

Only 7% of Americans get their health insurance through non-group coverage, according to Kaiser [1]

It's not nearly enough to counter-balance to huge influx of high risk subscribers. You're being hung out to dry with the high risk pool, which is why your costs have skyrocketed.

"Most people are healthy most of the time, and as a consequence, health care expenditures are heavily concentrated in a small share of the population: about 50 percent of the health care spending in a given year by those below age 65 is attributable to just 5 percent of the nonelderly population. The lowest spending half of the population accounts for only about 3.5 percent of health care spending in a year." [2]

If you want to fix ACA, you have to fix the risk pool. So what's the best way to get healthy people signing up for ACA in droves?

Imagine if you could take your employer contribution, and legally apply it to any plan of your choosing. As-in, sure the employer could arrange a group plan for the office, and you could take it or leave it, but you got to apply the exact same employer-contributed dollars to any plan you chose if you wanted.

Then on top of that, if you could get ACA income-based subsidies, regardless of the amount of the employer cost-share. Because, why on earth should you get less subsidy at the exact same income level, just because you have an employer who is also good enough to contribute?! That's just penalizing employers for contributing. Employer contributions would be an add-back to MAGI for purpose of calculating the subsidy, but nothing more. Currently, today, the meagerest employee contribution will disqualify an employee from all subsidies altogether, almost regardless of income. So-called "affordable" employer-sponsored coverage disqualifies an employee from all subsidies, is defined as an employee share of less than ~10% of household income for an individual plan. WTF?!)

What you would end up with is some extremely cheap plans which a lot of very health workers would flock to. The Fed would pay out significantly more in overall subsidies, but the payment of subsidies would be significantly more fair because it would not penalize an employee for working for an employer who is actually willing to contribute to a share of health costs.

In practice, it would in quick order eviscerate the group market for employer-chosen plans, and see employees taking proper responsibility for choosing their own plans for themselves, while still preserving the ability for employers to share in health care costs with tax-advantaged dollars. It would save millions of small/medium sized businesses the arduous task of trying to negotiate group health plans for their employers evey single year. But most of all, it would fix the risk pool by getting everyone across America actually buying through the marketplace, and not the skewed microcosm we have now.

Early on after ACA passing, I think it was Zenefits was actually trying to sell employers on paying employees to purchased their own plans on ACA marketplaces years ago, until the IRS shut it down. But it was an extremely appealing model at the time.

[1] - http://kff.org/other/state-indicator/total-population/?curre...

[2] - http://healthaffairs.org/blog/2016/03/15/dont-let-the-talkin...

I was being hung out to dry before the ACA and paying about double for near equivalent coverage.

Double what?

Pre-ACA a non-group plan that wasn't some government mandated high risk pool would typically be much cheaper than group coverage, simply because of the fact that it went through underwriting and you could be denied.

It was priced similar to life insurance where a healthy young subscriber could get a very cheap premium because the expected value was so low.

Back when it was legal to charge 10x more for a 55yr olds plan than a 25yr old, people paid more in line with their expected utilization. Flattening the rate curve shifted massive costs to young middle class families, which IMO is shit policy. When you're 55 you are generally done raising the kids and saving for their college, so it's actually not a bad time for your health care premiums to skyrocket.

That wasn't my experience at all. Health insurance was literally three times more expensive for me throughout my perfectly healthy twenties compared to now as I'm nearing 40 (on an ACA plan).

If we are swapping anecdotes, my experience is the opposite of yours. I'm paying almost double what I paid 10 years ago, and my deductible is four times higher, with separate deductibles for drugs, and a smaller network of providers. Along with higher co-pays, and coinsurance now.

Double the monthly fee for an equivalent full HMO plan that was about the same as I was making when I was working for a Fortune 500. I now pay a little over 1/2 what I paid pre-ACA for an equivalent plan through the ACA marketplace in NY state.