ACA and driving premium costs up and availability of insurance down.
The only way to make a dent in insurance premiums is to get more healthy people in the insurance pool. The penalty provision is a device to get everyone to jump in the pool. It was initially set to low, but instead of tweaking it, the Republicans through the whole thing out. So people didn’t jump in the pool anymore and pools were left with older less healthy populations which drives premiums up.
In addition the Republican killed the early period Subsidies for insurance companies to cover losses until the pools got large enough, so insurance companies simply pulled out of many markets also driving premiums up.

[Post edited by 111Balz at 10/14/2020 1:16PM]