>So what do you think would have happened without the ACA? I know that our health insurance cost was going up year after year after year, and going up a lot.

ACA doubled down on everything that is wrong with American Health Care.

"Health Insurance" is a misnomer for our system.
True insurance is used to protect against catastrophic losses, not ordinary expenses.

Without getting wonky about it, the best comparison is homeowner and fire insurance.
It is true insurance:
* It protects you against large and unpredictable losses like a fire.
* It does NOT cover mowing the lawn, periodic painting, replacing broken windows, and other ordinary expenses.

So, what was wrong with our system pre-ACA?
* Too much bureaucratic overhead, especially for small dollar amounts.
* "Somebody else pays" = No regard for cost by patients or physicians = Out of control spending.

The simplest example of "Somebody else pays"
* Poor people taking their sick kid to the ER instead of a GP - because they will never pay the bill.
* The ER visit is like $3000 but somebody else pays, so they don't care.
* Visiting a GP would cost $50 or $100 out of their own pocket, so they opt for the "Free" ER visit.

ACA has robbed me of the only tool I had left to combat out of control medical costs:
Buying a low cost "Catastrophic" policy and paying out of pocket for ordinary expenses.

Paying out of pocket - as I did when I was uninsured, I had a surprising amount of control over cost.
I had the same medical problem while insured and again while uninsured.
* Insured cost for treating a kidney stone = over $10,000 with like $700 out of my pocket
* Uninsured cost for treating a kidney stone = about $300

Why was the insured version so expensive?
Initial GP visit = $70
Painkillers = $15
MRI = $700
A useless ER visit = $3,000
Two outpatient procedures to clear the stone = $7,000

Why was the uninsured version so much cheaper?
Initial GP visit = $70
Painkillers = $15
MRI (non-insurance cash price) = $225
ER Visit - declined = $0
Outpatient procedure - declined = $0
3 gallons of water and a day of agony to flush the stone = $6.00 (Walmart bottled water tastes better than tap water)

Can I shop and cost-control every medical expense?
No. Duh.
A heart attack or car crash injuries would be impractical and stupid to price shop medical treatment.

Before ACA, i could have purchased high deductible catastrophic medical insurance for like $6,000.
After my experience price-shopping medical care while uninsured, I was leaning that way anyhow.

So, comparing to my present ACA-compliant plan, I would have had another $11,000 every year in my pocket to cover out of pocket medical bills.
And yes, a very high deductible plan would have exposed me to a loss of $20k in a very bad year.
But having $11k more in my pocket EVERY year would soften that a lot.

Some people don't believe that medical costs can be controlled with Econ 101 supply and demand in the free market.
In fact, medical procedures are like anything else - normal Econ 101 supply/demand and competition in the market DO drive down prices over time.

Lasik vision correction is not covered by insurance.
People pay out of their own pocket, and doctors compete on price, service and quality.
* "Today, LASIK is done with a computer-guided laser. ... it cost $3,800"
* "less than half the 1997 cost with a much shorter recovery time and lower risk of human error."
* Forbes Magazine Mar 23, 2012

In short:
Expensive layers of bureaucracy and regulation drive costs up over time and give us the quality service like we expect at the DMV or Post Office.
Competition in a free market drives costs down and improves quality over time.