ObamaCare was always a raw deal. Rather than fix a busted system, it forced everyone to participate in it, all while promising that, somehow, that would magically lower costs. No surprise, but reality has been a bit harsher. John C. Goodman of the Goodman Institute of Policy Research and Kansas state senator Beverly Gossage explain an important aspect of this.

When Democrats passed the Affordable Care Act of 2010, President Obama and lawmakers made the same claim over and over: The act would make good, affordable health insurance available to people with pre-existing conditions. The actual result has been the opposite. ObamaCare makes health insurance as good as possible for the healthy and as bad as possible for the sick.

According to President Biden, health insurance in America is free or almost free (“as little as $10 a month or less” after subsidies) for about 80% of people who acquire it in an ObamaCare exchange. Most preventive care—the only kind of care healthy people require—is also free.

If you are sick, things are different. Consider a hypothetical middle-aged couple in Dallas earning $70,000 a year. Suppose they have two children, both of whom have serious birth defects. Although this family will pay no premium for a Blue Cross bronze plan in the ObamaCare exchange, they will face a $9,100 deductible for each child. Their total out-of-pocket exposure is $18,200 a year.

It gets worse. Patients with serious diseases often require the care of highly trained specialists who usually work at centers of excellence. But that family in Dallas will discover that their Blue Cross plan isn’t accepted at leading cancer providers nearby, including Baylor University Medical Center and the University of Texas Health Science Center, or MD Anderson Cancer Center in Houston.

The problem isn’t unique to Texas. ObamaCare plans have very skinny networks in every state. They tend to pay providers Medicaid rates or close to them. As a result, ObamaCare looks like Medicaid with a high deductible. A great many providers, including prestigious medical institutions, won’t accept Medicaid managed care — the version of Medicaid most recipients receive — or ObamaCare.

The pair explain other scenarios for how ObamaCare works poorly and then make a critical point: “If you wonder why ObamaCare was designed this way, consider that it wasn’t designed by Mr. Obama or by Democratic lawmakers. It was designed by special interests.”

Ultimately, they conclude, “Most people with serious health problems who have to buy their own coverage would have been much better off in the pre-ObamaCare health system.” And Congress has little interest in doing anything about it.

Wall Street Journal subscribers can read the whole thing here.