The Affordable Care Act (ACA), also known as Obamacare, was signed into law in 2010. In short, the intention of the program was to provide more affordable healthcare coverage to the American people. However, as we have seen over the last few years, what has happened is this once seemingly promising program has turned out to be detrimental to the middle class, hurt small businesses, significantly increased insurance premiums and has been generally detrimental to the American healthcare system.

For years, Republicans have promised to repeal and replace the ACA, yet despite desperate support from President Trump and Speaker Paul Ryan, the vote in the U.S. House on the highly anticipated Republican bill, the American Health Care Act (AHCA), was cancelled the day of the vote. The AHCA was opposed by Democrats and some moderate Republicans, who felt that the cuts to healthcare were to severe, and also by some far-right conservatives who felt there was still too much government intervention, referring to the bill as “Obamacare 2.0.”

In 2014, several major revisions were made to the ACA, namely the implementation of small business tax credits, federal subsidies allocated based on income and a requirement that those with preexisting conditions could not be denied coverage. Prior to that in 2013, there were an estimated 44 million Americans who had no health insurance, about 16 percent of the population. By 2015, this rate had fallen to below 10 percent of the population. According to a survey conducted by the New York Times in 2015, the majority of those not covered by health insurance were working-class families who could not afford coverage, which is ironic considering how the ‘Affordable’ Care Act has raised rates significantly for everyone else.

While Obamacare has put millions more Americans on health insurance, the program has been detrimental to the working and middle class. The poorest of Americans gain the most from the program, benefiting from the lowest deductibles and highest subsidies, the result of which has been the skyrocketing of rates for everyone else. According to a study conducted by the Kaiser Family Foundation in 2008, the average employer-sponsored family plan cost employees $3,354. By 2016, that cost had risen by over 50 percent to $5,277. Furthermore, the number of covered workers on high-deductible plans of at least $1,000 has increased from 35 percent in 2008 to a majority of over 50 percent today. What has happened as a result of the continuously rising rates is that the working and middle class are seemingly only willing to pay for the unappealing plans if they are sick or have a preexisting condition, because to do so otherwise would make little financial sense.

The main problem with the current American healthcare system as a whole, as well as the failed AHCA, is that the mixture of privatization and federal control that is not compatible in its current form. What needs to happen is one of two things, either increasing privatization to promote competition, or having a totally federal system. The latter of the two options has already been implemented in many parts of the world, particularly in Europe. Founded in 1948, the National Health Service (NHS) is a publicly funded national healthcare system in the U.K., established on its founding principles of being comprehensive, universal and free at the point of delivery. It also happens to be the oldest single-payer healthcare system in the world. Over the years, the NHS has proven itself to be a successful and sustainable healthcare system, favored by most people across the political spectrum. That being said, the NHS does suffer from problems commonly seen in federalized healthcare systems, particularly the shortage of doctors and availability of hospital beds. This often results in long wait lists for treatment and operations, and people being sent home early when not fully ready, which can be particularly detrimental to the elderly and those who are in life-threatening situations.

In the U.S., many doctors have been long against the Affordable Care Act, arguing that the wave of rules and regulations prevents them from providing proper care to their patients. In a story for CNN, Atlanta urologist Brian Hill said “the ACA took this terrible broken healthcare system and added a lot of burden onto physicians.” A side effect of the ACA has been the irrevocable power that insurance companies now hold in the healthcare industry. Nowadays, patients walk into a doctor’s office or get some procedure performed on them, often not knowing how much they will eventually have to pay out of pocket, because it depends entirely on how much their insurance company is willing to pay out. “We’re losing the focus of who we’re supposed to be taking care of: the patient. You’re not my customer anymore. Now, I’ve got to respond to the federal bureaucracy, not you,” Hill said.

The replacement for the failing Affordable Care Act has been long overdue, and the significant opposition to and failure to pass the American Health Care Act means that it will be months, if not years, before the real change that much of the American people want will be implemented.