The ACA is not "health care." It's an insurance regulation. The conflating of the two is a useful narrative but it is not accurate in any way.
In the pre-ACA insurance marketplace, pre-existing conditions either precluded individuals from coverage or forced them to pay for more expensive plans. Self-employed individuals were in a similar position.
Without insurance, health care, ranging from the mundane to emergency room coverage, was/is exorbitantly expensive. What rhetorical clarity, then, do we gain by explaining that the ACA is not health care?