I don't want to argue. But your first sentence shows that you don't know the situation of everyone. You said, "The only reason that the ACA has a prayer of maintaining affordable premiums....."
The thing is...the ACA does not have "affordable premiums" for everyone.
For a middle class older person, premiums are unaffordable. Mine start at over $900/month...for bad coverage: HMO, $4,500 deductible, small provider lists, narrow drug lists, only 2 ins. cos. (and the other one is more expensive than the $900/mo.).
That's the group of people I'm speaking of. I'm transitioning into Medicare soon, so the ACA no longer will affect me soon.
But the ACA does not provide "affordable insurance" for everyone.
The ACA allows insurance companies to charge an older person TRIPLE RATES, even when they are healthy.
Here's a factoid: At one time, I was paying over $800/mo. for lousy insurance (I couldn't find a doctor to take it, because it was one of the low level metal plans), while someone I knew who was younger and unhealthy and worked less than I did was able to afford SILVER or GOLD level great plan.
The government was charging triple rates to people like me, so that other people could get not just the same coverage as I got, but BETTER coverage than I could possibly afford, at a fraction of the cost. AND they used it a lot. (I, OTOH, didn't use the ACA at all for years. I couldn't find a nearby doctor to take my low level plan, but I was in excellent health, so not a problem.)
Something was out of whack. It would have been great, if the ACA had been fixed to prevent that unfairness. For instance, the rule that let the ins. cos. charge older people triple rates could have been rolled back entirely, or even back to just double rates.
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