We've gone over this a number of times before, but this article does a decent job of pointing out some of the structural problems the ACA has had in various states — most of which have been where GOP opposition has screwed up the model under which the exchanges were to work. Rather than trying to fix it, Republicans at the federal and state level have been out to break the ACA since it was passed. Remember that every time Trump or Ryan or their cohorts talk about how the ACA is "failing."
Why Are So Many insurers Leaving Obamacare? – The Atlantic
How rejecting Medicaid and other government decisions have hurt insurance markets
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The ACA is an ugly baby. Not surprising, it gets its genes from both sides of the family.
It does have the potential to be a lovely program if it's father's don't kill it first.
I still don't get why the Medicare/Medicaid expansion was a hell no.
And how in hell people voted for the lawmakers that did that.
Now it's biting them in the ass.
There was so much in this that I don't understand.
The ACA is a whole bucket of compromises, and about as far from a universal health care system as one could cobble together, and hasn't at all been helped by the sabotage and refusal to improve it by the GOP.
That said, it's an order of magnitude better than the status quo ante.
+Gretchen Sher Medicaid's efficiency varies from state to state. It is nowhere near as well run as Medicare. Some healthcare providers will accept Medicare patients but not Medicaid or HMOs. They don't want the hassles associated with Medicaid or HMOs.
+Gretchen Sher I still don't get why the Medicare/Medicaid expansion was a hell no.
In two words: "because socialism".
They saw it as an attempt to expand single-payer, and they wanted people to keep the freedom to die in the gutter.
This is why we can't have nice things.
+Valdis Klētnieks It also means they don't have to make improvements to Medicaid.
+Gretchen Sher And bear in mind that electoral pressure did have an effect. A number of states whose governors initially opposed the expansion later, more quietly, adopted it.