“HCSMs are not regulated by the ACA. The coverage you get will vary from one HCSM to another, but they are not required to cover pre-existing conditions, cap out-of-pocket costs, or cover essential health benefits. And they can still have annual and lifetime benefit caps.”
Since they’re not regulated entities, there’s no enforcement mechanism if you get sick and they decide not to pay out or delay your reimbursement.
Taking about free markets in the context of US health insurance in general is a waste of time.
The law is basically written by the insurers, and favors them. It allows them to segregate people based on who they work for, etc.
In an ethical system, there would be just a single, non-segregated pool of people called a 'market', and anyone would be able to purchase any plan they want from that market, regardless of which state they lived in and regardless of who they did or did not work for.
Federal employees have such a system, and prior to obamacare, there was actually bipartisan agreement forming around enabling everyone to participate in that system. It's probably why obamacare was rushed through quickly by the insurance companies.
It should be quite evident that everything about this system is broken, but this is part of how broken systems get entrenched.