Not really. The idea of insurance is to protect against an uncertainty that an individual can’t pay out of pocket without serious repercussion. A group of similarly situation people pool their money on the chance that their house might burn down, that their car might get totaled, or that they will be diagnosed with a serious illness. All things which may happen to an individual, but won’t happen to all individuals, compensating those who actually experience the unfortunate event.
But in all of these cases including health insurance (prior to 1/1/14) to play fair, you had to purchase the insurance prior to the unforeseen happening to that no cheating was allowed. You can’t buy car insurance after you’ve crashed, or homeowner’s insurance after your house burned down. Likewise you couldn’t buy health insurance after a cancer diagnosis.
Also, underwriting was done to adjust premiums based upon your propensity to have the unforeseen event happen. If a person had 2 DUI convictions, his auto insurance was adjusted upward to account for the increased risk of crashing his car.
Health insurance now does none of these things. It “insures” against known outcomes: doctor visits, contraception, and mammograms. Now it “insures” against known outcomes like cancer patients needing chemotherapy. Allowing people who have already experienced adverse events is similar to writing an insurance policy for a person who’s home is already on fire. It increases premiums for those who don’t have these “pre-existing conditions.”
But health insurance has been bastardized to the point where it is impractical for a person to sign up for health insurance at birth and keep the same policy for life to correct for the “injustice” and has caused those with health problems to fall through the cracks. So there needs to be a fix to get healthcare for those with health issues.
The ACA “fix” was to put the expense squarely on the middle class.
To directly answer your question: Yes, all insurance passes this cost in a forward looking manner so it is fair to all involved. The ACA does this in a backward looking manner allowing people with known risks to be covered by people with little risk.
Some object to the comparison as it isn’t a person’s “fault” that they are sick unlike how it is a person’s “fault” if they have had DUI convictions to increase their auto insurance premiums. While true, it matters little to the basic principles of insurance to allow such a thing.