The Affordable Care Act (ACA) was the most significant expansion of health coverage since Medicare and Medicaid were enacted. The law resulted in approximately 13-20 million uninsured persons gaining coverage. Despite these gains, the ACA has numerous shortcomings. For progressives, the ACA was a unique opportunity to provide access to high-quality, comprehensive, equitable health coverage to all persons living in the United States. Using this perspective as our framework, in this review we highlight some of the limitations of the ACA and potential areas for refinement. We conclude that the ACA fell far short of the goal of achieving universal coverage and that the coverage made available through the ACA was not equitable. In addition, the ACA expanded coverage by building onto a highly fragmented, inefficient, and costly health system. Thus, it did little to control health costs. A more fiscally prudent approach would have been built upon more successful existing programs, such as a Medicare for All.

中文翻译：

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完善平价医疗法案：进步的观点。

自 Medicare 和 Medicaid 颁布以来，《平价医疗法案》(ACA) 是医疗保险覆盖面最显着的扩展。该法律导致大约 13-20 百万未投保的人获得保险。尽管有这些好处，ACA 仍有许多缺点。对于进步人士来说，ACA 是一个独特的机会，可以为所有居住在美国的人提供高质量、全面、公平的健康保险。使用这种观点作为我们的框架，在本次审查中，我们强调了 ACA 的一些局限性和可能需要改进的领域。我们的结论是，ACA 远未达到实现全民覆盖的目标，并且通过 ACA 提供的覆盖范围不公平。此外，ACA 通过构建一个高度分散、低效且昂贵的卫生系统来扩大覆盖范围。因此，它对控制医疗成本几乎没有作用。一种更加谨慎的财政方法将建立在更成功的现有计划之上，例如全民医疗保险。