 Consider now the third model of what we should count as equal access, which we refer to as the choice model. Actually, this model is couched as a version of universal access (as opposed to universal coverage), and we shall have to infer the notion of equality. So what is its commitment to equality of access? The foundational intuition behind it can be found in Paul Ryan’s words that no one should be forced to do what they don’t want to do. If the intuition focuses on what anyone wants to do, then there is a concern about equality after all. It cannot be an intuition that focuses only on what some people want to do if they are rich enough to have certain choices. It rules out choice that is forced on individuals by their being unable to afford to do what they prefer to do. Such a forced choice was typical of what people faced on the individual insurance market before the ACA if they bought skimpy but affordable health insurance (e. g., high deductible plans that are cheaper because they do not cover certain needed services). For a choice to buy or not buy insurance coverage to be a real choice on this view, both choices have to be ones people could select, if they wanted to. This feature rules out a choice between a health care insurance scheme people cannot afford vs one that they can afford. Subsidies must be available to those with limited resources that make their choices real. This requirement makes the model more expensive to implement than the Republican plans allowed. Real choice has costs given the income inequality that prevails in the U.S. The costs have a compensation that has a bearing on “equality,” for everyone is equal in the choices that are possible for purchasing insurance, and individuals have more room to express other priorities than the purchase of health care. 