“It was corporate statism, painted in the pastel colors of progressive compassion.”
By Dutch Rojas
The ACA was the greatest piece of legislation ever passed? Spare me.
Such a claim is not merely hyperbolic, it is historically illiterate. The Affordable Care Act, passed in 2010, was not a triumph of reform but a masterpiece of political theatre and economic distortion. It did not fix the American healthcare system; it calcified its worst features.
The ACA mandated coverage inflated prices while distorting risk. One of the ACA’s proudest boasts, essential health benefits, became its most economically illogical mandate.
Insurers were forced to cover services like maternity care for men and pediatric dentistry for retirees. Risk pools were distorted. Premiums soared. The healthy were penalized to subsidize the inefficient.
In pre-ACA America, a healthy 30-year-old could purchase catastrophic coverage for a few hundred dollars a month. Post-ACA, that same individual faces a $1,200 monthly bill for insurance they neither want nor need. The state declared, in effect, that every American must buy a Cadillac, even if they only needed a bicycle.
Third, insurance is not access. The claim that “50 million Americans gained coverage” is semantically clever and substantively hollow. Coverage is not care.
The expansion of Medicaid, a key pillar of the ACA, placed millions into a program that few physicians accept and that delivers subpar outcomes. The middle class, meanwhile, found themselves with narrow networks, enormous deductibles, and unaffordable care, all behind the illusion of a plastic insurance card.
This is the Potemkin village of healthcare: coverage without capacity, access without agency.
Third, and most damning, the ACA codified a healthcare cartel. Section 6001 of the law effectively banned the creation and expansion of physician-owned hospitals.
Why? Because those facilities outperformed corporate health systems on quality and cost. The empirical record was clear. So instead of fostering competition, Congress, lobbied by the AHA and its allies, shut it down.
Imagine a world in which Amazon had lobbied Congress to outlaw any new e-commerce startups after 2010, under the guise of “market stabilization.”
That is precisely what happened in healthcare. The ACA chose incumbency over innovation. It outlawed the insurgents and rewarded the monopolists.
In sum, the ACA is not a monument to progress, it is a monument to protectionism.
It preserved the oligopoly of legacy health systems. It empowered insurers by mandating the purchase of their products. It distorted prices, crushed physician autonomy, and locked out competition.
To call it the “greatest” legislation of our time is to mistake technocratic complexity for genuine reform.
It was corporate statism, painted in the pastel colors of progressive compassion.
