the pre-existing conditions rule alone is huge.
Which has had what effect?
Better health outcomes for those with "pre-existing conditions"? Because that isn't the case, and unless diabetes suddenly changed to be more aggressive and deadly I don't see any externalities that would explain the data. Do you?
Better financial outcomes? There was a small period between 2013-2018 where this was arguably true, for specific people. But it does show in general trends enough to maybe be true for a time.
The metrics you're talking about might not be from the ACA effects, but from other issues hitting the health care industry over time.
Yes, and disentangling those is hard. However, the implicit assumption you're starting from is that the externalities were significantly greater. I would agree that is somewhat true for COVID and it's downstream effects, but there isn't anything else I can really point to. Do you have something?
that dwindled because the facilities couldn't support the demand because of closures or not enough staff. That's not the ACA.
You sure? Because I can draw a pretty straight line between the ACA and private equity gutting healthcare facilities for the tax credits and direct payments that were promised by the heritage foundation.