>>FWIW, there's a family history of very early cardiovascular disease that would provoke an exclusion if Paul ever had to seek health insurance on the open market. Whatever else you may say about the ACA - pre-existing exclusions, rescissions and refusals are unlikely to be politically acceptable ever again. Which is a HUGE positive step whatever else may happen.
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>Why is it positive?
>The insurers could have done that on their own a long time ago but opted not to in order to keep premiums low for people with lower risk of incurring catastrophic costs.

This pretty much describes why the market is the wrong thing to apply here. Everyone is trying to squeeze the last dollar out of it, and guess what - insurance works best when it's a negligible cost but, since everyone pays, it all averages out. The premiums aren't big but the accumulated amount can sustain even cases of epidemics. There aren't any options, so the huge paperwork tracking who's got what and when does it expire simply doesn't exist. And the administrative manpower unburdened by that is actually used as a cost watchdog.

But no, it had to be the market. So you get options, and you actually pay for the guy who is trying to trick you into not reading the small print. Which you should read very carefully, because it's not your health that's getting covered, it's your diseases, which you have to pick. You need to know what you may get sick of during the year, in advance. In cars, that would be "should I insure the whole engine but not drivetrain, or just drivetrain but not wheels" and then you don't get reimbursed for the crash because your brakes were covered but ABS wasn't.