A different way of looking at the ACA is that it represents a bargain between liberals and conservatives, although not one that was ever explicitly made. The left got 32 million people covered and reforms that eliminate the worst abuses in the health insurance system. And the right got a further push, beyond the momentum already underway in the market, towards just the kind of "skin in the game" insurance they have always believed will help control health care costs. It’s the big victory in health reform conservatives seem not to realize they have won.
The irony of the health-care reform law, which included a lot of ideas proposed during the Gang of Six’s negotiations even as it didn’t include any votes from the Republicans who were part of the Gang of Six, is that conservatives got a lot of their ideas into the bill, but did not themselves have to put any “skin in the game” to get them there.