The “free market” era that existed before the ACA, and that Republicans would return to, left 50 million people uninsured.
These people, when confronted with a health emergency, went to hospital emergency rooms (the highest cost component in our health-care system), where their immediate needs were met and they were discharged – until their next health emergency.
And mandates?
As a nation we are awash in mandates.
If you violate the mandate you are fined or face other sanctions, e.g., if you drive a car, a taxi, a commercial truck, there are various speed limits, or limits on hours of work; exceed the limit, pay a fine.
These are all requirements that must be met; mandates that if not met give rise to fines and penalties.
In the ACA there are only two mandates, and both are necessary to keep insurance costs down, to optimize the benefits of health insurance, and thereby reduce overall health-care costs.
The second ACA mandate simply puts a floor under all health insurance policies.
Nothing in the ACA prevents the more affluent from obtaining whatever level of health insurance coverage they need, want, or can afford.
The reality is more, not fewer, people in our nation need access to minimum health-care insurance at costs they can afford.