For your friend - could you get your congressman to help? A friend of mine did that to get her disability faster and it worked. Also, would your friend qualify for Medicaid?

Another option is to offer to paly in cash for doctor's visits but negotiate a lower price because you'll be doing so. Many hospitals and doctors will cut the amount they charge if they know up front you'll be paying in cash since it cuts their paperwork. With expensive procedures you can often negotiate a payment plan based on your income. But you have to ask.

BTW, I actually thought the ACA was the wrong option. I would have preferred expanding Medicaid to cover mroe people. I thought it would be a cost effective option that would not lead to higher premiums while providing medical care for those who needed it, including those who lose their jobs. But obviously we need SOMETHING.

I also think we need to make penalties much harsher for employers who screw employees. I once got screwed out of having medical bills paid for an on-the-job injury. I should have sued but I was only in my 20s and had no idea how to go about it. But the system in this country really does screw the poor and many other groups.

We need something better. JMHO