Healthcare is the most extreme example of Republicans clutching to the fantasy that the free market fixes everything. The ACA was pretty flawed, but it was better than nothing.
"How much does that big Mac cost?" "Eat one. I will then send a bill to your food provider. They will tell you what share of the price, made up behind you back & after the fact, you are responsible for paying."
They are always a major payer and so hospitals will do what it takes to be Medicare certified. In high density areas there can be enough rich people for a hospital to not bother.