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I don't live in the USA any more, so I don't follow the details of the ACA. However, it seems to be a small step in the right direction. To avoid being bogged down in details, it helps sometimes to think about what an ideal health care system would look like (ignoring costs for the moment). What I'd like is a system where any citizen can go to any health care facility and get the best care possible, at no cost to them. Now think about what's the best way to make that happen - or get as close to it as you can afford. I don't have answers but I know what I'd like to see - a society where good healthcare is one of the benefits of citizenship.