" Throwing Fits " * Survive Will It * The program is designed so that the government will compensate individuals with earnings between 0% and 400% of the poverty line so that their out of pocket maximum does not exceed some progressive percentage of their gross income . Thus , the affordable care act was recently funded by congress for those affording to purchase subsidized insurance from federal exchanges administered by privatized insurance providers . * Bass Ackwards * en.wikipedia.org/wiki/Fifth_Amendment_to_the_United_States_Constitution#Text ...; nor shall private property be taken for public use, without just compensation. The growth in costs to health care for government as a portion of the national debt is a fiscal concern . In essence , government sought to negotiate and purchase health insurance for any individual earning between 0% and 400% of the poverty line , and progressively set monthly reimbursements to those individuals depending upon their earning percentage . The affordable care act did get government out of the medical insurance business , by shifting government administration for medicaid claims to the private health care industry for management of patient records , premium collection , cost schedules and payments for treatment . Prior to the affordable care act , government interfaced with private health care providers , set cost schedules to pay for billed procedures , and paid for the balance through collected taxes or increased national debt to creditors . After the affordable care act , private insurers collect premiums and actuaries calculate methods to offsets losses through private investment including liquidity in the money supply . As government cannot be supposed to subsidize or socialize insurance premiums for individuals with gross earnings beyond 400% of the poverty line , government does not have any say and cannot leverage any penalty upon those individuals for not holding personal insurance . Removing the individual mandate was a political cop out for the republicans who wanted a tax increase on the poor , since the affordable care act does not completely compensate those qualifying for socialized insurance , and removing the individual mandate only exacerbates the original problem that medicaid payments by government are a compelling concern because its costs adds to the national debt . Thus , those individuals opting out of paying the premiums and bilking the government when they are admitted for medical treatment are costing taxpayers by not contributing their part for the overall costs of citizen health care to government . The affordable care act changes the means by which the statistic of cost to government for citizen health care are calculated ; and , whether the affordable care act has been or is expected to be less costly to government and more efficient and effective for private citizens and health care providers has yet to be presented to the public for evaluation . The primary issue is the whimsical manner by which private health care providers bill and by which private insurers make payment decisions for valid costs of treatments . These health care issues can be wildly indeterminate : paying cash for a procedure is a different cost to paying for the same procedure with HSA that is different than paying for the same procedure through the insurance provider ; procedures have different costs depending upon the service provider ; whether a pharmacy is a friendly affiliate of ones health care network determines cost of medications .