I used to use SQS but Postgres gives me everything I want. I can also do priority queueing and sorting.
I gave up on SQS when it couldn't be accessed from a VPC. AWS might have fixed that now.
All the other queueing mechanisms I investigated were dramatically more complex and heavyweight than Postgres SKIP LOCKED.
As for acking, I see two common methods: using an additional boolean column, something like is_processed. Consumers skip truthy ones. Or, after the work is done, simply delete the entry or move elsewhere (e.g. For archival / auditing).