I purchased a marketplace plan through the ACA the first year it was available. After years of being a 20something and self-employed with no insurance my career began to take off and I earned enough to buy into the exchange. The marketplace was a mess from the outset, but not because of politics.

First, few doctors took the premium plans (platinum, as they were called), leaving very few options in my city and the surrounding areas. I did not qualify for a subsidy, but that was besides the point. I sought a manageable premium and found it. However, the quality of care diminishes when only a small handful of doctors have agreed to and signed the necessary paperwork to accept the exchange plans. That alone created an enormous backup in scheduling appointments. Further, the doctors who were available were in hospitals that did not meet my standards or had issues (poor reviews, etc). And yes, there are low-standards hospitals. I did not expect world-class care.

Second, once you bought into an exchange plan the insurance company began hiking the rates as soon as possible. I would receive monthly snail mail from the Department of Health to inform me that the provider sought to hike my premiums. This happened very frequently in a single years' time. Since you paid up front and could only enroll at a specific point in the year, you were under pressure to continue paying out. The state could only block the provider from gouging you by small measures. The providers understood that the low initial premium number was to get you in the door. They then followed with nonstop rate-hike threats that would eventually price me out of the exchange altogether. Each time I received a letter, the rate ticked up a double digit amount. Death by a thousand cuts.

I spoke to a doctor who explained that the insurance companies treat their exchange plans differently than they direct-purchase or employer-based plans. They required the doctor to jump through hoops that included extra paperwork and handling their internal bureaucracy. Also, compensation was not upfront or regular which discouraged the practice from taking on the plan. Providers made it difficult or annoying for doctors to take the plan, so many did not, including mine.

I left the plan when the premium number reached the same amount as a direct-purchased plan from another high quality company. When you looked at the initial rates on the ACA the following enrollment period, you realize you were forced into overpaying for your exchange plan for a period of months. The initial buy-in was low, as it had been when I started.

The game is simple: Hook them with a low-rate, use sizable company resources to pursue rate hikes, make accepting the insurance unpalatable to doctors, and expect a steady number of low-income purchasers to be priced out and quit before they can effectively use their insurance (many young people who purchases plans are in good health). If many folks simply bought in and dropped out in enough rotation without using the insurance, they could turn a steady profit.

In the meantime, they could use the ACA as an excuse to pursue rate hikes in elsewhere in their insurance offerings. There's a million arguments used.

I eventually bought a direct price plan that rarely went up, as it was already insanely overpriced. But it was secure and accepted everywhere. Since then I have insurance through my company.

My experience leads me to believe the ACA was the best stop-gap measure the administration could achieve at the time. Single-payer that is universally accepted, like Medicare, would be immune to this blatant gaming. But that wasn't possible at the time.

Obama and the administration knew that once a populous is given an entitlement they will never let it go. Hence most American's resistance to privatizing social security. By insuring as many as they could while upping the coverage age to 26 and eliminating pre-existing conditions denials, the opposition would be forced to play ball and move in the direction of a single payer system... eventually. The ACA allows too many windows for abuse and I believe was never intended to work as is. It was meant to shift the debate from "should we address medical issues" to "how to we fix this easily fatigued plan."