I lived through that, uninsured, for five years or so as a business owner - to “rich” to get subsidies, too poor to afford 20k+ per year for nothing except a theoretical out-of-pocket max (I say theoretical because there are many exceptions, loopholes, and the annual reset). Being hammered by the IRS for this was.. just.. swell.
So for me Obamacare sucked because it made the cost of individual market plans completely unaffordable and then taxed me for not being able to afford it. As a business owner responsible for employing others, it seemed especially ridiculous because here was a strong disincentive for me to continue on, which would mean a negative ripple effect beyond just me, i.e. layoffs, if I shuttered the operation.
Once the individual mandate went away, and some new options for employer cost sharing like QSEHRA/ICHRA came about, it has gotten a bit more manageable, but most small business owners I know still struggle with healthcare. Cost sharing programs like CHM are about the only workable alternative but they don’t offer the kind of bankruptcy protection a solid insurance premium would cover, and they are religious by nature. Alternatively, DNR and a term life insurance policy.
Best option is to be married, have spouse work for the man to get into corporate group plan for family, while you grow your business enough to sustain an insurance scheme.
But it sucks out there on the individual market - the raw actuarial numbers to insure you are bad - and subsidies disappear quickly with any amount of AGI. Since the vast majority of Americans are on employer-paid healthcare plans, this is a view into it that most don’t see. The cynical side of me (as a small business owner) says this is by design to keep you working for corporate America - consolidation of labor, consolidation of the profits. For me, Obamacare further entrenched this aspect of the system, which has become more terrible, not less.
This has not been true for 2021 and is not true for 2022.
Your payments for health insurance are limited by a cap that is hard to explain, but basically, you should not be paying more than 8.5% of your AGI for the 2nd most expensive silver plan in your state.
I (self-employed) have an AGI in the mid-100k range, and these subsidies more or less reduced my wife and my insurance payments by half.
This system still sucks - we are paying private corporations, via government subsidy, for their overpriced goods and services. But from a numerical perspective, it's much closer to being inline with most of the rest of the industrialized world: 8-14% of income for health insurance that covers most stuff.
And in all likelihood, Congress will not renew it at the end of this year.
I am currently paying $800/mo for a "silver" plan in a state that did not accept the extended Medicare. No, I don't get subsidies. I believe my deducible is roughly $2000, although I don't know because all of my costs have been covered, including the trip to the emergency room after I wacked myself in the eye. (The out-of-pocket limit for 2022 is $8700 for an individual. (https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...))
Before the ACA, individual market plans were cheaper (although for the first couple of years they were comparable), but did not cover asthma (as a "pre-existing condition). Hello, $750 daily inhalers.
Just out of curiosity I calculated roughly the cost in Germany. If you were self employed and made 5.000 € a month your health insurance would be somewhat around 900 € per month. Partly tax deductible if I am not mistaken.
So quite a bit of money. But probably manageable for many/most people.
I am lucky. As I only do freelance work on the side I am insured via what I pay from my main income. So no additional costs for me as long as I don't make more on the side than in my main job.
I wanted Medicare for everyone (still do), but politics...and lies about "government death panels"...
In general when someone retires they're old enough to be eligible for Medicare (government-sponsored health care). My dad was. But my mom was just enough younger that she wasn't eligible for Medicare when he retired. There were (and still are) all kinds of weird gaps like this.