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7 Years after the ACA was signed, there are still inequalities in healthcare availability and affordability within the states.

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The ACA did not fail, but it did not fulfill all of its goals.

Healthcare became more accessible but not more affordable.

Changes will require evolution. With a system as large, convoluted, and complicated as the U.S. health care system, it is sometimes necessary to try first, learn, and improve -- in order to arrive at a new system that works entirely.

The ACA was not designed to provide universal health care, only to make it more available.

More people have health care available today that did not previously have coverage.  Those who benefited the most from the ACA include:

Students (covered by parents until age 26)

Older adults with pre-existing health conditions

Not everyone won with the ACA. Those who did not benefit so much from the ACA, as was initially intended, include:

The young, well, generations who earn lower incomes, and whose premiums were often far above the tax penalty for not buying insurance.

Those living in states that did not extend Medicaid coverage to those well below the poverty line but too young for Medicare.

Without restrictions, companies will raise prices and pass them to the consumer. We cannot repair the current system without curtailing the number of players, restricting the ability of insurance companies to charge premiums based on individual or group risks, and target solutions to the cost of healthcare both at the point of care and on the side of pharmaceuticals, medical equipment, and medical devices.

Health policy is highly nuanced and requires a significant amount of time to construct, vet, and implement.  It may not be possible to roll out such a plan with the interference of politics.

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from Arkansas Center for Health Improvement

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Is Obamacare Working? The Affordable Care Act Five Years Later

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The comprehensive health care reform law enacted in March 2010 (sometimes known as ACA, PPACA, or “Obamacare”). ... The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level.
retrieved from Healthcare.gov

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According to APHA, there are several compelling reasons for healthcare reform in America, including:

Too many people lack health insurance.  Roughly 20% of the population under the age of 65 are uninsured which places a huge burden on the system.

The cost of healthcare in the United States is unsustainable.

The high spending on healthcare does not appear to indicate great health in America.

The system focuses on treatment instead of prevention.

There are significant health disparities between populations in the United States. Access to care and preventive measures is not ubiquitous.

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Make health insurance affordable and accessible to more people.

Expand the Medicaid program to cover all adults with income below the 138% of the federal poverty level.

Support innovative medial care delivery methods designed to lower the cost of health care in general.

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President Barak Obama signs the new health care bill in Washington on March 23, 2010.

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Institute for Healthcare Improvement - IHI

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ACA and AHCA: Don Berwick Breaks It Down

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Although more people have coverage; about 24% more, there continues to be a huge volume (~38 million) of the population that are uninsured because they cannot afford the premiums.

Good Intentions - Poor Execution By forcing insurance companies to cover everyone, under their standard risk framework, the number of sick and infirm outweighed the number of well people, causing the system to be out of balance, driving up the costs.

The penalties for staying out of the system were far lower than the burdensome cost of compliance. People quickly learned that the penalty for not joining a plan was equal to one month of insurance coverage (roughly).

Allowing people to sign up after a catastrophic event meant they could sign up "just-in-time", which everyone knows is economically smart.

ACA had no impact on the rising costs of healthcare.

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ACA and AHCA: Don Berwick Breaks it Down.  (2017, May 23). Institute for Healthcare Improvement.  (2021). Retrieved from https://www.youtube.com/watch?v=KoTOzNRw8bg

Affordable Care Act (ACA). (2021). HealthCare.gov Glossary. Retrieved from https://www.healthcare.gov/glossary/affordable-care-act/

Affordable Care Act in Arkansas: Policy Decisions & Coverage Impacts. (2021). Arkansas Center for Health Improvement.  Retrieved from https://achi.net/aca/

Board, E. (2016, September 9). Why Obamacare failed. Chicago Tribune.  Retrieved from https://www.chicagotribune.com/opinion/editorials/ct-obamacare-fail-health-care-insurance-medicine-0911-jm-20160909-story.html

Graetz, I., McKillop, C., Kaplan, C., Waters, T. (2018). Lessons Learned From the Affordable Care Act: The Premium Subsidy Design May Promote Adverse Selection. Medical Care Research And Review. Retrieved from https://www.ehealthinsurance.com/resources/affordable-care-act/history-timeline-affordable-care-act-aca

Why Do We Need the Affordable Care Act? (2021). American Public Health Association. (2021). Retrieved from https://www.apha.org/-/media/files/pdf/factsheets/why_do_we_need_the_aca.ashx?la=en&hash=3978DD3792B6096D59BFC