As a green-card holder, he qualified to purchase health insurance through the Affordable Care Act marketplace. But when Rangel was diagnosed with a hernia, surgery became unavoidable. There, his hernia repair would have cost about $7,000, but once he added thousands of dollars in travel expenses, that option no longer made financial sense. In April, he traveled to the Affordable Hernia Surgery center in Rockville, where he said “an efficient, well-coordinated system” guided him through the entire process. Kravitz then pulled out an estimate another patient had received for an inguinal hernia repair from a different large health system.