Did the market reforms imposed by the ACA work? From the perspective of barriers to coverage, the primary barrier today is not the inability to find coverage if you are sick but rather the ability to pay for coverage regardless of your health status. Health insurance costs continue to rise as the underlying cost of healthcare skyrockets. There needs to be a significant increase in the number of low risk individuals in the insured pool. NAHU believes we can achieve the greatest positive impact by empowering the competitive forces inherent within the private-market system through five key solutions.