I don’t understand this meme. If you have an hmo you’re supposed to have a primary care doctor/physician. If you have ppo then sure, it would make no sense to have a primary care since its not required to see a specialist. But since in the us you have to have insurance, most of the cheap insurances are hmo, so why would not having enough money mean ppo or other policy like it?
When the aca was passed, insurance was mandatory. Sorry i forgot that the gop tax bill in 2017 repealed the individual mandate penalty. Some states still do have a penalty for being uninsured.