In this episode, Tom Quigley takes on one of the most misunderstood laws in modern America: the Affordable Care Act (ACA).

Rather than arguing politics, Tom breaks the ACA down as a tool—what it was actually designed to fix, what it fixed well, what it broke, and why most people arguing about it don’t understand how it works at all.

This conversation reframes the ACA not as “Obamacare vs. anti-Obamacare,” but as a set of rules that smart individuals and businesses can legally leverage—if they understand them. And that’s the problem: most don’t.

Tom explains the original intent:

• Eliminate pre-existing condition exclusions

• Standardize coverage across plans

• Ensure:

  • Preventive care

  • Catastrophic protection

  • No lifetime limits

• Close loopholes left by earlier HIPAA laws

At its core, Tom says:

“The intention was solid. The execution got hijacked.”

Tom emphasizes the most important change:

• Insurers can no longer deny coverage due to health history

• This protects:

  • Self-employed individuals

  • Contractors

  • People between jobs

  • Families facing sudden diagnoses

He shares a real-life example involving his wife’s cancer diagnosis, explaining how understanding ACA timing rules, plan tiers, and qualifying events allowed them to:

• Upgrade coverage temporarily

• Reduce out-of-pocket exposure

• Use supplemental insurance strategically

• Switch plans again during open enrollment

Tom:

“If you understand the law, you can take full advantage of it—legally.”

Tom doesn’t mince words:

• Most people don’t know what the ACA actually does

• They argue emotionally, not factually

• They repeat talking points without understanding the mechanics

Tom:

“You can’t fix stupid—but you can educate the people willing to learn.”

The ACA regulates:

• Required 10 essential benefits

• No lifetime or annual limits on those benefits

• Participation rules

• Rate increase oversight:

  • States regulate small group & individual increases

  • Federal oversight kicks in above ~9.9%

What it does not control:

• Hospital pricing

• Administrative bloat

• Insurance agent commissions

• How employers design benefits around the law

Tom clears up a major misconception:

“Every legitimate health plan today is an ACA plan.”

The ACA isn’t a product—it’s a rulebook.
Insurance companies still:

• Design plans internally

• Create pricing tiers

• Incentivize agents to sell higher-premium options

That’s where things go wrong.

Tom calls out the core structural flaw:

• Group health agents are commission-based

• Higher premiums = higher commissions

• Better designs = lower commissions

• So better options are rarely shown

Tom:

“It’s costing businesses millions because no one wants to get carved out.”

Tom explains how ACA and HIPAA interact:

• Groups with valid waivers (ACA-compliant plans) count toward participation

• Even if only a few employees enroll, the group can be treated as 100% participation

• This creates huge flexibility—if you understand it

Most employers don’t.

Major cost drivers untouched by the ACA:

• Hospital pricing

• Drug pricing

• Administrative layers

• Agent compensation models

The ACA standardized coverage—but not costs.

Tom explains the irony:

• Pre-ACA plans had:

  • Lifetime caps

  • Limited preventive care

  • Higher real costs

Yet people still resist ACA plans out of misunderstanding or ideology.

Tom:

“They want fewer benefits, more risk, and higher costs—and think that’s freedom.”

Yes—but not the way politicians argue about it.

Tom’s two realistic fixes:

1. Universal catastrophic threshold (e.g., $50,000 deductible with reinsurance)

2. Government-funded high-risk pools to stabilize pricing

Both could be paid for by:

• Taxable income created when premiums drop

Why hasn’t it happened?

“Too much money is being made.”

Tom distills it down to one issue:

• People don’t understand what they’re buying

• Employers don’t understand the rules

• HR departments aren’t trained

• Agents benefit from confusion

Result:

“Doing the same thing every year and expecting different results.”

“Every plan today is an ACA plan. People just don’t realize it.” — Tom Quigley