I was serving on the Medicare Advisory panel at the time and the panel was disbanded shortly before the ACA was announced. In its place the President appointed an "advisory" panel made up of the lobbyists I mentioned above. he did that in order to gain their support for whatever healthcare initiative he would eventually get through his party in Congress..and the democrats wanted to avoid the massive insurance company resistance that opposed Hillarycare. At least that is what I was told by Zeke Emmanuel, with whom I served on that advisory panel. Zeke was also adamant about not allowing ANY private practice or conservative on the new advisory committee. The goal was to end fee for service and they saw the ACA as the stepping stone to do that.

The lobbyists wrote the major tenets of the ACA and gave them to the Congressional and Senate staffers, which is how they were put in to the ACA.

The so called "Republican Amendments" to the ACA were nearly entirely protocol amendments which had to do with the procedural aspects of getting the bill through Congress. There was very little about healthcare implementation in those GOP "Amendments".

The ACA is a lobbyists dream. It has brought about a major monopolization in the delivery of healthcare.

Any claim that the ACA is a "Republican" idea, or bipartisan in any way is outright false..perhaps even delusional.