So, like about 1 in 4 folks in Texas, we went without.
This is a common misunderstanding. For most people in this situation, the laws on the books already took care of the problem. If she already had healthcare insurance at her previous employer, if she could show continuous coverage, she would be able to continue to purchase healthcare insurance privately, despite her preexisting condition.
Whether the private insurance would be affordable to you is a different question, but it's not true that a preexisting condition was, before Obamacare, a complete roadblock to acquiring coverage privately.
Under HIPAA, continuous coverage ensures acceptance into group health care plans (for instance, employer-provided coverage) regardless of preexisting conditions.
Further, continuous coverage ensures acceptance into some form of individual coverage, of a kind determined by the specific state you're in.
I do not believe it is the case that continuous coverage guarantees acceptance into individual health care plans.
In 19 years of working, and (more relevantly) 15 years of marriage, I have never had a lapse of health care coverage for myself or my family. When we started Matasano, I had just previously left a full-time, full-benefits job at a larger company where I'd been working for 4 years. I elected COBRA when I left, and started shopping for individual coverage.
We were unable to get family coverage at any price in Illinois because of preexisting condition concerns for two members of my family. In both cases, the rejection cause was a total surprise, because the "condition" wasn't an ongoing health problem, but rather a piece of medical trivia that caused underwriters concern that there might have been more significant issues down the road.
I shopped for insurance myself, and then with a professional broker who I paid to deal with the problem, and who could not find a way around it.
We solved the problem first by my wife taking a full-time job outside Matasano, which got us group coverage, and then by starting group coverage at Matasano.
And you're right; I believe that there were options open to her, specifically our state's high risk pool, which wasn't a viable option due to price.
But, heck, if price isn't a factor, why do we need insurance at all :D ? I mean, we always have the option to just purchase healthcare directly; whether that will be financially feasible, is, of course, "a different question".
We had to move for other reasons than her job, but consider that there are many people doing work that other people do, who are motivated to do things like start a business, but who are otherwise unable to do so because of the US healthcare system.
Additionally, consider my parents, who are also working not because they need the income per se-- they could retire and live well-- except for the costs and difficulties of purchasing health insurance on a private market.
So it isn't the case that people are just universally "going on the dole"... making private insurance closer to the same cost to purchase health insurance regardless of your status as an employee shouldn't affect the overall bottom line of the leeches who provide insurance.