I don't understand all of your post, but two questions:
Why do we assume that ER visits will be the norm, and that the cost will go up? The ACA will be REPLACED. I don't know why that is such a hard concept to understand. It will be REPLACED. They have already pledged to keep "preexisting conditions" and the "mandate", so "millions" aren't all of a sudden going to be out of insurance.
Okay, one question and one comment: I am adamantly against the ACA. I can only speak for me, but as someone that isn't bugged by the notion of "socialized healthcare" (we've had it in one form or another since the mid 60's, and in earnest since the 80's) and who recognizes that despite being a fervent free-market advocate, single-payer is the way to go if we are committed to subsidizing our nations healthcare, I would have been a lot more supportive if:
- they had taken more care in the crafting of the bill, and not rammed it down our throats with a haste that was unseemly (and resulted in a LOT of iterative changes after the fact)
- they had taken more care in lowering the transactional costs across the board; the only way you do that is increase the transparency, and that didn't happen
- Obama didn't prove himself to be a sell-out politician by cutting a massive deal with the pharmaceuticals - $80 BILLION and a guarantee of profits - while throwing the insurers under the bus
- they didn't gut provisions that promoted the single biggest weapon against increased costs, WELLNESS. The Flex Spending program, for example, was gutted, and only useful when coupled with, surprise surprise, more bureaucracy
- they didn't do dick about the state-by-state regulation, which is probably the single biggest contributor to increased costs
- they did little to break the odd and unwieldly union between employers and insurance. It makes no sense, and contributes to the increased costs
Name it whatever you want, but do it better. That it worked, nominally, in ONE STATE for $5 million people is not determinative that it would work in a nation of 52 states and 325 million people. Wait, that's cards in a deck. 50. 50 states. Right?