One, leave some people uncovered.
Two, leave some people charged at rates they can't pay
Three, raise prices.
The only variables are "who" and "how much."
Changing priorities on different areas of the board has been guiding the entire conversation for years, and will continue to do so.
From what little I've read of AHA, it was little more than ACA lite, trying to placate everyone benefiting from ACA while accommodating those bearing the costs. It was going to do neither and so died.
Trump claims the ACA will explode on it's own and the Dems will own it. He's wrong on both counts.
The Dems have been sitting back and blaming the gaping holes in ACA on Republicans not expanding Medicaid for years, there's no reason for them to stop now. (that that argument is not so much robbing Peter to pay Paul as it is kicking Peter in the balls for not having the foresight to bum some cash off of Paul before being robbed is another argument, but I digress. A lot.)
It's also not going to explode so much as deflate. The higher costs are going to drive more insurers out of the exchanges and drive more consumers to take the tax hit out of sheer financial necessity until the exchanges will have no more traffic than a dying mall.
I'm not sure how much of it is long-term planning by the Democrats and how much is the whims of timing, but it could go either way.
I don't see a single legislator not seeing this, and arguing along party lines.
The Dems spent the remainder of the Obama administration kicking the loss can down the road as much as possible (the employer contribution, the tax penalty, ect) in order to "front-load" the benefits while leaving the penalties down the road as much as possible, betting that it would stay long enough to be politically untouchable.
The Reps were banking on enough of the penalties hitting hard enough to make it politically toxic in the same time frame. Thoughts of replacing it would be difficult even if the Republicans weren't full of scisms. As it is, well, we can see that today.
My guess is that the can will keep getting kicked until some Democrat looks at it and says, "well, we tried the free market. We'll just have to go to single payer."
And that's when it really gets hideous.
Because the two big penalties for a single-payer system are such.
One, single payer is single controller. If what you get isn't working and you want another option, or even another opinion? Tough shit. Double tough shit if they've already done enough of what you need until next quarter.
Two, without the hope of profit, innovation dies. The reason big pharma pumps ungodly amounts of money into drug tests is the promise of an even more ridiculous payoff later. They're like hollywood execs pouring $200 million into a summer blockbuster, planning to take home $1 Billion or more from it. (which makes bitching about generics from Canada more or less the torrenting argument, with about as much maturity as you'd expect, but moving on).
Ultimately, there's a ton of moving parts and much more ways to fuck it up than there is to get it right.
And ultimately, you need to cross aisles to get it done effectively.
Because only a cold-hearted bastard doesn't want to at least ~try~ to save them all.
But of course, only a fool thinks they can ignore triage.
Ultimately, I think this is something we can find a solution for, for want of being cantankerous, but still an optimist.
I still think in 50 years, there's going to be some eccentric teacher saying, "Yeah, Obama gave 'em hope. Then 45 showed up and they got off their collective ass."