The ACA left millions of people uninsured for a variety of reasons - the most damning of which imo is insufficient subsidies for working men, women and their dependents (read children and elderly family members). I mean, if you're going to keep voting for corporate Democrats and thereby allow your government to continue to be the handmaidens of the Wall Street/Banker/Big Pharma fascist class then you ought to at least print enough money to allow people working full-time to pay the oligarchs for private health insurance. But they didn't do that, hence, "such as they are."