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The main thing that is wrong with the ACA is the opposition by the Republicans and their attempt to constantly try to kill it - with no idea of what they would replace it with…..But certainly the ACA has its issues and opportunities for improvement:It was intended that each State would expand their Medicaid problem which funding was from the Federal Gov’t for first number of years and then shared cost. This was originally mandatory but the Supreme Court ruled that this was a requirement the Federal Government couldn’t force on the States - and as a result a number of Red States didn’t expand despite the benefit to their citizens. The number of uninsured would have gone down far more had they not played the political card. Republicans need to come back to the table and participate as part of a larger revamp.Some States have very little competition and their population is also less healthy. This combination makes for expensive insurance. It seems like the only way to address this is to have some element of a pool or subsidy to make it affordable.Some of the largest insurers chose to sit it out and watch and wait due to uncertainty of the cost and pent up need of the population. I think the two things that can be done are to require or incentivize insurers in each and larger multi-State insurers like United, Humana, Cigna, WellCare, and Centene to participate on the Exchange.There are probably many more that others might suggest but these are 3 that I see as issues.

He is absolutely correct about the ACA (Obamacare.) It is collapsing. As for Medicaid, it depends upon how one defines “working.”Evidence that the ACA is collapsing abounds.Aetna has exited the market. Aetna’s exit alone will force over 600,000 people to search for new plans.United Health has exited the marketCarepoint Blue Cross is exiting MarylandCigna has exited the marketIn 2018, at least one credible forecast is that one in three counties in the United States will have only one providerThis month (May 2017), the ACA became extinct in 94 of Iowa's 99 counties, as a small insurer, Medica, which had been the last man standing, followed Aetna and Wellmark Blue Cross Blue Shield out of the program.A 2015 McKinsey study summarized that insurance carriers are losing, collectively, $2.5 billion per year. That number has risen substantially over the last two years as Aetna, Cigna and Humana have all indicated they've lost money.More than one insurance CEO has stated that the ACA is in a “death spiral.”Think it's all because they're greedy corporations? Well, 22 out of 23 nonprofit healthcare coops are losing money too, and 12 out of 23 have gone bankrupt. Perhaps there's something systemic there.In many major markets, insurance premiums are rising more than 20%Most participating carriers claim that the healthcare pool is older and sicker than would be necessary for a well-functioning risk poolThe CBO had forecast that by 2017, more than 24 million people would be enrolled. 2016’s enrollment was flat, and there are less than 50% of the people forecast that are enrolled — roughly 11 million people are participating.Even from the consistently pro-ACA folks at Vox, we have:Declining choice, far fewer signups than forecast, carriers exiting the marketplace, executives declaring it in a death spiral, carriers collectively taking large losses and citing that the pools are far sicker and older than forecast… perhaps someone can explain why these, collectively, are not signs of collapse.Going back a few years, let’s review the most significant, most-oft-repeated promises of the ACA:“If you like your plan, you can keep your plan, period.”“This is not a tax.”“If you like your doctor, you can keep your doctor, period.”“A site as easy to use as Amazon.”“We can do all this without adding one dime to the deficit.”“The typical family of four will save over $2,500/year.”These statements were made frequently during the sales phase of the ACA and shortly thereafter. They were repeated often on the campaign trail because they resonated with voters. They mattered. They’ve not been delivered.As for Medicaid, that’s a pretty big topic, and one that is probably addressed on a separate Quora thread. On many measures, Medicaid is doing what it’s charged to do. On other measures, it will be a huge fiscal burden on states and the federal government unless very significant changes are made. Ryan’s statement that it’s “not working” is quite subjective, based on what “working” means.

If you believe that Obamacare should be removed than why not open interstate commerce for insurance companies?It already is the same companies.Anthem is one company - but it offers products based on which states it is licensed in. UHG, Cigna, BC/BS, Aetna all do this in similar fashion.Due to STATE regulations and STATE imposed structures - it “looks” like a different company.Due to STATE regulations and STATE imposed structures - it “looks” like a different insurance policy.Due to STATE regulations and STATE imposed structures - it “looks” like a different address for the claim.But when people actually look past the media hype and lack of full disclosure - it is the same claim format, the same basic billing location and the same core policy for MOST of the states. What changes isthe P O Box, which is state specificthe policy details, which are state specificIt is even more uniform when you look at Medicare Gap coverage - wich is standard based on CMS regulations.