Think he is suggesting the ACA did absolutely nothing to address the root diseases (if you will) afflicting the American healthcare system. Poverty causes people to "abuse" the ER. Abuse of the ER drives up healthcare costs across the board. Sky-high healthcare costs render insurance untenable for the impoverished. Goto ER.
Really the only thing the ACA accomplished in the end was curbing denial of insurance or claims rejection due to that "pre-existing condition" horse shit. Or I would assume, I don't know of actual numbers on that. For the vast swathes of Americans living at or near a minimum wage that hasn't been able to support "living" in decades, insurance remains unaffordable.
As long as for-profit insurance exists, there will be no real improvement to the healthcare system. ACA was a half measure in a battle where there can be none.
Steam + PSN: PHJF