>>http://www.vox.com/2016/12/13/13901874/obamacare-trump-voter-health-insurance-repeal

Re the anecdote in this citation: by my calculation, they were without insurance until the husband got sick, at which point the ACA guaranteed coverage without pre-existing exclusion and subsidized their cost.

This is a perfect illustration of why individual mandate is needed, and it's also a reason for rising insurance premiums.

I feel very sorry for this family... but this not a celebration of the ACA at work, it's a warning of how the ACA can be brought crashing down unless the whole scheme is honored, including the obligation to contribute to the pool when you're well, not just after you get sick.

FWIW, you might think these thorny questions don't arise in single payer models where coverage is automatic. But always there are visitors from the third world who can become very sick and nobody wants to refuse them care. Countries like NZ seek reimbursement from wealthy visitors who are usually insured anyway, but write off big costs for people who can scrape together $399 for an airfare on sale but can't pay for renal dialysis or cardiac stenting if they get sick. Government also reviews cases brought to them with special needs and often covers care on humanitarian grounds. E.g. after 30 years I'm sure there's no PHI risk in recalling an unfortunate Fijian child with a severe back deformity and paralysis after a fall from a coconut tree. NZ government brought him and his parents over and got them into specialty spinal surgery. But as always, healthcare will cheerfully consume the entire GDP unless rationed- and these days even stabilizing somebody and sending them home where there is no provision of care available in NZ, is morally tough.