You could, but costs would be high, though I see your point, maybe less than what people are paying now.
Not having insurance, though, is taking a big chance, for if there was a medical catastrophe, hospital bills could cost someone a lot of money, if not bankrupt them.
Even going to an ER if you do have insurance gets costly. The way mine works is that I pay I think it's up to a $200 deductible (way up from much less than that not too long ago) if you go but are not admitted to the hospital from there. If you're admitted, they waive the deductible. This is their way of telling you whether it was appropriate for you to go to the ER or not, since office visits are much less. Basically the large copay is a deterrent for insured people from going to the ER (for issues that probably could've been seen in a doctor's office).
Also, see my next reply...
This, I'm not sure about - having worked in a major urban ER and a major urban hospital. Caregivers have no idea what's going on with anyone's insurance, tbh; nor do we care much other than for what is best for the patient. What would happen is that, upon admission to the ER or hospital, a non-insured patient would have to sign a waiver saying they were responsible for paying out of pocket. I suppose it might come up when a treatment plan is being discussed, if only to say hey we recommend an MRI or whatever. The uninsured patient would then say, wait, do I really need it, because I am paying out of pocket. So, in other words, recommendations would be what they are, but the treatment plan might be limited unless one's willing to pay the full price for all the treatments recommended. When it comes to inpatient, what happens is if major treatment is necessary, that patient is hooked up with a social worker who then helps the patient apply for Medicaid or disability, whatever they can get. So if quality of care does go down, it is likely because things are so expensive and someone who's paying themselves might want to limit care to the bare minimum until they get some assistance. That's what I see, anyhow. Caregivers know very little about a patient's insurance issues.
So do you mind if I ask, is the subsidy based on income? Do you happen to know what criteria is used? And when you say this is something new, do you know if this was in the original ACA guidelines? Or how did this make it in there? Thanks