Perhaps I am being overly simplistic, and I do support ACA reform, but I don't believe there is a silver bullet to reforming ACA. If there was Republicans would

Perhaps I am being overly simplistic, and I do support ACA reform, but I don't believe there is a silver bullet to reforming ACA. If there was Republicans would already have come up with it and would have been publicizing it for the last 8 years. The fact remains - covering pre-existing conditions, kids till 26, and low income households is expensive. You can pay it by increasing the insured pool - which is what ACA tries to do via the individual mandate, or by introducing a single payer system whose buying power would be so big that they will substantial leverage over healthcare provider. As a society we have decided that a single payer system is socialist, so it cannot be adopted here (and it has its own problems - wait times, lack of R&D incentive etc.). So now we have to choose between not providing healthcare to 40-50 million people or pay increased premiums to cover for those. Some reforms that may somewhat bring down the premiums: - Offer subsidies to even middle income people, not just poor. May be set the income limit by geography - Make the individual mandate more expensive to incentivize healthier people join the pool - Offer a public option