Sure it did. What we see today is a feature, not a bug.
I, too, believe the ACA results are intentional.
Just try to point out health care rationing and high taxes in the Canadian system, they will reply that it is free and universal so any shortcomings and inconvenience is worth it. As if dropping dead while in the rationing queue is merely an inconvenience.
The insurer I buy my ACA policy from cynically moved into geographic areas that would otherwise have been “bare,” to offer barely adequate policies with a poor record of getting payment to providers.
Additionally, it is quite evident that they focus their marketing materials on people of color who may have never bought their own policies before, i.e., naive consumers who think they are getting robust coverage.
I’m convinced companies like this routinely deny a certain percentage of legit claims that they know is required to turn a profit.
And they are state-specific, so I highly doubt a second opinion from an out-of-state institution would be covered, so far I haven’t needed one.
So I can either have Zero insurance, or zero insurance.