From my vantagepoint, the cost of healthcare insurance under the individual mandate was/is still too high for many people working minimum-wage or marginal-wage (i.e., unable to afford to live independently of parents, spouse, roommates, etc.) jobs. There's also the issue of the long-term unemployed, many of whom fall off the grid because the government seems to think they don't exist if they're not collecting unemployment insurance or Welfare. For many of these people, the penalty is well less than the cost of insurance -- or, because they don't have any income (and are living on the generosity of family and friends), they can't afford either (and no income, no income taxes filed, no penalty).
The big insurance issue seems to have come about only when, as a population, we moved from "traditional indemnity" plans to HMOs, PPOs, and EPOs and when Medicaid/Medicare reimbursement policies forced healthcare providers to a single payscale and forced them into harriedly-quick and overworked appointment schedules. Now, instead of paying a relatively affordable fee each time you went to the doctor (and being able to just drop in if you became ill overnight), your doctor's flat (unnegotiated) rate is closer to a week's salary, because s/he has to scale it up to be able to afford the negociated-down payments from Medicaid/Medicare and the big HMO/PPO/EPO managers, and you can't just pop in because s/he is scheduled full from dawn to dusk with "every 15 minute appointments" to meed Medicaid/Medicare's demands -- forcing you to go to an "urgent care center" like CVS Minute Clinic or MedEx or something similar.
The other things that have grossly changed since my youth are the proportion of an average person's salary spent on housing (it used to be 25% of your net salary, now it's more like 30-40% of your gross salary) and the number and amount of monthly utilities we have (it used to be just gas, electric, and telephone -- now it includes mobile phones, cellular-enabled tablets, high-speed internet point-of-presence, internet services such as cloud storage and web space, television programming, and often radio programming).