This bill does not address the real reasons for rising premium costs. There need to be considerable changes to the ACA. IMO it is the involvement of the insurance companies in the process of providing healthcare that is the problem. Remove the insurance companies and you remove the need for premiums. The costs of healthcare should be paid by the federal government with each citizen paying a share of the cost into a fund the way we pay into Medicaré. This can be an add-on to the deductions we already see as employees. For unemployed or self-employed worker, their contributions can be deducted from their checks or automatically deducted from their checking accounts monthly, just like any other routine payments like utilities. Access to services would be by using the social security number as with Medicare. Such a system will provide the federal government with a means of tracking use of services. These numbers will provide the basis for negotiating with service, equipment and supply providers. The federal government as the negotiator will be placed in a position of power with regard to negotiating with the providers.The larger the quantity purchased, the lower the negotiated price. Removing the middle man insurance companies from the process and increasing the pool of insured to include the entire American population will benefit both patients and providers. Such a system will have its challenges, especially initially, but it will be better than it is now. And in such a system every American will receive a basic level of care, and every provider will receive a fair price directly from the purchaser.