What’s important to understand about this trilemma is that it means, roughly, that every change has winners and losers. Put bluntly, the Affordable Care Act’s changes are raising insurance premiums for some people who did well under the old system and lowering them for many of the people who were locked out or discriminated against.

A good example of the tradeoffs is the case of Dianne Barrette, a 56-year-old Florida woman who’s been featured in the media because her current plan will cost 10 times more under Obamacare. As Erik Wemple discovered, her old plan was health insurance in name only. It didn’t cover inpatient hospital care, it didn’t cover ambulance services, and so forth. Under Obamacare, all plans have to cover those benefits. So Barrette’s old plan was extremely affordable — $56 a month — because it covered basically nothing. Her new plan is much more expensive but also much more generous.

But it’s not all zero sum. The law pumps a trillion dollars of subsidies into the market to help people making less than 400 percent of the poverty line — which is $94,200 for a family of four — afford insurance. So now the actual premiums people are paying exist on a continuum, with some people seeing premiums increases and some people paying literally nothing at all
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The final factor here is increased transparency and competition among insurers — which should bring down premiums over time. Spiro and Gruber credit competition for Obamacare’s lower-than-expected premiums. We’ll see if it sticks.

So the bottom line is that Obamacare makes insurance more accessible and more comprehensive, which raises average premiums, but it adds subsidies and competitive markets, which lower premiums. Whether premiums are higher or lower for an individual person depends on their precise situation. But premiums are, in general, lower than was expected when Obamacare passed.

I used to have one of those plans…when I lost my job I was rejected for an individual policy due to preexisting conditions (allergies). I then went to a policy that was 6 months in length (and cost $331 monthly). It had decent coverage, but after the initial 6 months, anything previously covered was considered preexisting and would no longer be covered. So…had I been in an accident during the first 6 months and been hurt badly, it would have covered expenses for that initial 6 month period only. And I would have had to pay for anything thereafter at 100%. I cancelled that policy after the initial 6 months. I went for 8 months without insurance. It was one of the scariest things in my life.

The other really disgusting thing I discovered in my 8 months of not having insurance is that everything costs more. You pay full, non-negotiated rates for doctor visits, medicine, etc. I have one allergy drug that costs $130 per month (the non-negotiated cost)…a drug that cost $50 as a copay when I was insured and cost $26 in Canada (as a foreigner, as I discovered after going to Canada, when I was still working, and realized that I had left that medicine at home.)

When you have no insurance you are screwed over every which way to Sunday.

Unless you have a ton of money, catastrophic policies are a waste of money. No one expects to get cancer or be in a major automobile accident. And with those types of policies, you’re mostly left holding the bag. And that would be a very heavy bag indeed.