> keep the preexisting conditions part and do away with the fines for not having insurance Mandatory enrollment is what makes it possible to have that preexist

> keep the preexisting conditions part and do away with the fines for not having insurance Mandatory enrollment is what makes it possible to have that preexisting condition part - the basic idea of this (or any) insurance is that it spreads the risks over a larger pool of people, with the insurance companies taking a cut of the money for administrative costs and profit. If you want to require that the insurance companies cover high-risk preexisting conditions without providing an increased customer base to spread those costs over then you'd better be prepared to see insurance companies go under. > increased costs of forcing insurers into the ACA Insurers don't have to participate in the ACA exchanges, and in fact many don't do so. Some participated in the beginning but decided there wasn't enough profit to be made or were losing money, so they've pulled out of the exchanges since then or have significantly raised their rates for their exchange plans. As an example of this, I believe United Healthcare (or its exchange-specific subsidiaries) no longer participates in most exchanges as of 2017 (http://money.cnn.com/2016/04/19/investing/unitedhealthcare-obamacare-exchanges-aca/index.html http://money.cnn.com/2016/04/19/investing/unitedhealthcare-o...). Interstate insurance competition isn't going to make it any cheaper to insure someone with a preexisting condition, or do you think that your local hospital is going to suddenly say "Oh, ccrush has insurance provided by a company in Montana! We can't charge San Francisco rates, we have to charge Montana hospital rates!" If you do think that, go talk to some hospital billing folks and they'll be happy to correct you. One thing that the ACA did put in is capping the amount that insurance companies could spend on non-medical expenses, including both administration and profit. All the stuff early on about non-compliant plans having to shut down? That was for crap insurance with high premiums, higher deductibles, crappy service, etc. but with EXCELLENT profit margins. After all, if I can sell insurance but drop you when the bills start to come in, then all of those premiums you paid me are profit.