federal government spending. In the United States, we spend more for our healthcare than any other high-income

nation, yet our health outcomes are worse than comparable high-income countries. In 2015, over 32 million people

in the United States, about 12.8% of the non-elderly adult population, were without insurance. Even today, however,

more than a decade after the Act was signed into law and after the Supreme Court mostly upheld it, a 2022 Kaiser

Foundation poll found that 42% of likely voters viewed it unfavorably. Why is this?

The debate over the ACA and healthcare reform could take an entire textbook, but what this chapter will do is

introduce the basics of insurance and the problems insurance companies face. It is these problems, and how

insurance companies respond to them that, in part, explain the divided opinion about the ACA.

Every purchase is based on a belief about the satisfaction that the good or service will provide. In turn, these
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