How do insurance rates go down if they have to pay, in your example, $80,000 for this procedure, and in the past, as this person would not have been covered, they would have paid zero? And in the past, if you were not covered, you would not have gotten the bypass as the hospital can deny treatment. If anything the ACA will create more demand for medical services, thus driving up prices. Forget about the idea of the ACA lowering insurance rates or medical costs. What the ACA doesis use taxpayer money to subsidize insurance costs. You want to make sure that costs go up, no better way that to start throwing government money at it.