It succeeded in getting more people covered by health insurance. It did so by enriching the private insurers who basically run our health care system. Personally I don’t see that as a success, rather it simply made all our health care system problems worse. Access to insurance just isn’t the same as access to health care, because the insurance costs money, and insurers tend to be roadblocks to care. People who tend to need the most care were either already covered (Medicare/Medicaid) or the subsidies under ACA were paltry jokes compared to their needs.
There isn’t a realistic chance of repeal. Both of the main political parties here benefit from it too much: the democrats by claiming a health care win, which our latte liberal class eats up, and the republicans by having an additional hot button issue (like abortion and guns) to whip their lunatic fringe up with. Not to mention all the campaign and lobbying money from private insurers who are profiting immensely off of ACA.
Private insurers don't run our health care system; provider networks do. When you include fee/service ratios for younger cohorts in the Medicare math, the administrative overhead numbers look a lot less compelling; more importantly, you can zero out administrative overhead from insurers and still only get a grocery store discount on services. The immediate problem with American health care is that providers charge too much for services, and secondarily that Americans access too many services.
It's also important to remember --- though I don't think it changes any of the fundamentals of the issue --- that the ordinary "retail" care that we access on a year by year basis, including short hospital stays, isn't where all the cost in the system is.
However insurance companies have absolutely no incentives for pressuring the providers to reduce prices, the opposite in fact because they get to keep a share of the revenue..
Medicare also pays unacceptably high rates for services; the idea that Medicare would successfully and meaningfully reduce those rates is more aspirational than empirical. One of the most important bottlenecks in health care affordability (residency funding) is explicitly maintained by Medicare.
There are tons of middlemen / services directly in between the consumer and the medicine or doctor the consumer ultimately needs (including insurance). Almost all of those middlemen are trying to maximize their own profits. The industry is complex and our entire society and economic culture is to blame, you really can't single out a single entity
There isn’t a realistic chance of repeal. Both of the main political parties here benefit from it too much: the democrats by claiming a health care win, which our latte liberal class eats up, and the republicans by having an additional hot button issue (like abortion and guns) to whip their lunatic fringe up with. Not to mention all the campaign and lobbying money from private insurers who are profiting immensely off of ACA.