I agree with you that it would have been much better if the ACA had made insurance compulsory by having real penalties for not being insured. Instead of a piddling 2.5% of income / $700 penalty for an adult, make it more like 10% / $3000 and enforce it. I’m sure the experts told the Congress / Obama administration to do this. I am also sure the politicians made a political calculation not to do it. Congress wanted to avoid doing anything unpopular, so instead they decided to play Russian Roulette with the risk pools and with the financing structure. The jury’s still out, but there’s a good chance there was a bullet in the chamber. Regardless, doesn’t much matter now after the election.
I disagree that healthy young people aren’t doing what’s best for themselves. They are. Old people just don’t like it because they aren’t getting to milk the young for their money. Too bad. The 3:1 ratio between old and young people is too low. It would have been ok if everyone had started paying into the ACA system at age 25 because then everything would even out over a full life span. But for a 55-65 year old to hop into a newly created system and expect to get subsidized by the young is just unfair and unrealistic. Cut the rates for young people, raise them for old people, and quadruple the penalties for not having insurance. I bet that will fix things.
BTW - I think I read this - there are about 10 million people with policies from the exchanges. There are about 7.5 million people who are just paying the penalty rather than getting insurance. There are another 12 million who decided not to get insurance and are given an exemption from the penalty. There are another 5 million who the IRS is still trying to figure out what they’re doing. So that’s 20 - 25 million people who should have insurance but don’t. Lots of people are making the decision not to get insurance, and we know they are disproportionately younger people.