Not in the least. Just to name a few of the ways the ACA changed things in the right direction for most "normal" ESI: - ACA threw out lifetime nor annual limit

Not in the least. Just to name a few of the ways the ACA changed things in the right direction for most "normal" ESI: - ACA threw out lifetime nor annual limits [0] - Essential benefits ensuring you have a more comprehensive plan that covers actual health insurance [1] - Ability to stay on a parent's insurance until you're 26 [2] - For every $1.00 your insurance company takes in from premiums, $0.80 has to be spent on patient care [3] - There's a max of a 3:1 ratio of age rating for health insurance premiums, irrespective of your health. It used to be that insurance companies would raise your premium or even cancel your policy if you got a costly disease like cancer [4]. The problem with your secular analysis is that there is not positive control for the "what if?" without these sort of policies. Most healthcare economists suspect it would have been even worse without the (somewhat modest) regulations that were imposed by the ACA. Again, this is high level policy analysis that requires dedicated study, and there's lots of evidence that the market has highly benefited consumers across most socioeconomic strata. [0]. https://www.hhs.gov/healthcare/about-the-aca/benefit-limits/index.html https://www.hhs.gov/healthcare/about-the-aca/benefit-limits/... [1]. https://www.healthcare.gov/glossary/essential-health-benefits/ https://www.healthcare.gov/glossary/essential-health-benefit... [2]. https://www.healthcare.gov/young-adults/children-under-26/ https://www.healthcare.gov/young-adults/children-under-26/ [3]. https://www.healthcare.gov/glossary/medical-loss-ratio-mlr/ https://www.healthcare.gov/glossary/medical-loss-ratio-mlr/ [4]. http://us.milliman.com/uploadedFiles/insight/2017/MillimanACAAgeBands_0131_Final.pdf http://us.milliman.com/uploadedFiles/insight/2017/MillimanAC...