In the ACA aftermath, I believe you saw more insurance companies exit markets because they couldn't be competitive and profitable on prices with standardized plans.
Which is its own problem and led to a lot of limited-insurer markets, but a different one.
The only reason the cost of college is high is because 18 year olds that know nothing about finance don't have to pay for it now because they can get loans.
You take away the loans, and you take away the ability of the college to charge whatever it wants and kids keep paying.
So what has changed? States have stopped funding for schools. A lot of tuition used to be covered by tax money, which spreads out the cost to everyone and over many years. Now, it is a very abrupt cost to a small group of people.
The prior funding model also had the benefit of a progressive tax system. Wealthier people paid into it more than poor people. Now, students have to rely on unpredictable financial assistance like grants and scholarships, and take on predatory loans to cover the difference.
Yes - but more importantly, schools got more expensive, because people had more access to debt.