So, how would you improve the Affordable Care Act, also known as Obamacare? I suppose half are going to say "UHC BABY" and the other half "DITCH IT", but I'd like to focus on potential fixes for the law that are legislatively possible. A couple of things about the law irk the crap out of me: 1)Subsidies come back to you after you file your taxes. This is just stupid to be blunt. If you have low-enough income to qualify for subsidies, why should you have to pay everything upfront only to get it back at the end of the year? I understand that the plans are already subsidized so, for example, I would only pay $300/mo for a plan that would have cost $800/mo before the ACA and then get a chunk of that money I pay back so that it winds up costing around $250/mo all told. However, it just doesn't make sense to me to have people pay the full price up-front. I can see no good reason for this at all other than maybe it's easier for the tax authorities to handle the subsidies/penalties this way. It's definitely a hardship for a lot of folks and is inconvenient and confusing. 2)Costs need to come down across the board; coverage should go up or both. I know that with the subsidies, insurance for individuals is now actually somewhat affordable. As with my earlier example, I really would have to pay $800/mo for coverage before the ACA. Now the government takes on the role that employers have traditionally played by paying for the bulk of the coverage and having individuals pay a smaller portion of it. However, the rates are still too high to be popular in my opinion. Yes, what is popular isn't necessarily good public policy. But in this case, people like me are having to decide if the almost-unreasonable rates are worth it or if they'll just eat the penalty. When it is the case that a lot of young, healthy people like myself are faced with this choice, it's really going to hurt the effectiveness of the law and drive up costs when we opt-out en masse. I am really struggling justifying paying for coverage that is a big chunk of our income for less-than-stellar coverage. I don't go to the doctor and don't usually have need to. The one thing the coverage would be great for someone like me is if I got hit by a bus or something. However, the crappy coverage means a massive deductible that is big enough that if I were hit by a bus I would still go bankrupt which defeats the purpose of the law. I understand that it's very difficult to have good coverage with low deductibles that are cheap. It's really not possible to be cost-effective that way. But on the other hand, if something isn't done to either make the law cheaper or increase coverage/lower deductibles, a lot of people are going to be skipping on healthcare coverage. At the end of the day it will be cheaper to just eat the penalty than it is to pay for the coverage that I don't really need and won't really help me when I need it most such as getting hit by a bus. In any case, while I think cost-effectiveness/cost-controls are great, the primary purpose of this law should be to provide affordable coverage to anyone who needs it. On that point it's failing I think. I'd mention the website as well but that issue speaks for itself. What say you all? --Oh crap, one other thing: They need to make the damn law easier to understand. I'm an informed consumer and I go out of my way to figure out stuff with regards to implementation of the ACA and even I am confused a lot.