[pigsinzen]

Before as well, of course. But prior to the ACA there was no requirement for every individual filing taxes to show they had coverage, or most businesses (even relatively small ones) to offer benefits packages.

It also changed small medical practices because suddenly everyone wanted to use this insurance they were paying for. No longer could it just be a doctor and maybe a couple of medical staff; they needed medical coders, specialized software, and so forth. Some decided to join large hospital networks (for worse, from what I have generally heard).

And this cascaded into multiple sub-industries developing around this revenue stream and the medical system. Everyone trying to sell something and grab their piece of the pie.

It was not great before, but you could go see a doctor and literally pay a small amount of cash for an appointment. Many won’t even accept anyone without insurance now.

Edit: as mburns@ pointed out, the IRS no longer asks individuals about their health insurance status since 2019.