The problem with most of the discussions about the ACA is that people are so emotionally polarized so we can't get any real conversation going. It's like talking about gun control. Me and many of my friends are passionate gun owners. I (me) can't even have a conversation with them about responsible gun ownership that involves anything like licensing, training, etc (even as a trade-off to open carry rights) because it means the "gob'ment is gonna take away my guns." Really? wtf?
It's the same thing with the ACA. First, the healthcare system in the US is really screwed up. The insurance companies / lawyers / lobbyist system we have ensures that the primary beneficiaries of the system are the insurance companies / lawyers / and lobbyists - not the citizens who need access to health care. The ones who are most vulnerable (poor and sick) get marginal care, if any. That's not right. There is no social justice in that system.
Many members of my family are right-wing conservative. The moment you mention social justice and taking care of the poor they start yelling and spitting, "All the poor want to do is to sit on their a$$ and collect welfare! I'll be damned if I'm gonna pay for their f*cking healthcare!" (these are real conversations that I'm quoting). Nevermind the fact that most of them are self-professed Christians who find it convenient to ignore one of the most fundamental tenets of both the Old and New Testament; taking care of the poor and less fortunate.
Given that, I don't think that the systemic problems we have with healthcare is going to get fixed from within the system. The system is designed to protect itself. Do you think the politicians who are elected using lobbyists money are going to vote against their constituents, or that the insurance companies are suddenly going to grow a conscience and decide that all those profits should be redirected to the "less-fortunate?"
I'm a strong supporter of less federal government. We should be moving back to the Federalist system with stronger state rights and responsibilities. I like the state-based marketplace idea of the ACA - at least as a start.