Jonathan Cohn, who was exploring the shortcomings of the American health care system long before the Affordable Care Act -- designed to address those failings -- was signed into law, explains:
Passing big pieces of legislation is a lot harder than it looks.
It demands unglamorous, grinding work to figure out the precise contours of rules, spending, and revenue necessary to accomplish your goal. It requires methodical building of alliances, endless negotiations among hostile factions, and making painful compromises on cherished ideals. Most of all, it requires seriousness of purpose—a deep belief that you are working toward some kind of better world—in order to sustain those efforts when the task seems hopeless.
Democrats envisaged a nation with universal healthcare and had spent decades focused on making it a reality. The issue was on the Democratic agenda. They worked to make it happen for millions of folks who, without the ACA, would lack affordable health coverage.
Republicans, indifferent to uninsured Americans and wedded to the idea of free-markets, had no interest in crafting public policies to expand access to health care. The GOP appears hazily nostalgic for 1950s-era medicine. In spite of Medicare’s enormous popularity, Ronald Reagan’s 1961 warning against "socialized medicine," still resonates.
Ensuring health care for Americans was not on the Republican agenda. In spite of campaigning for repeal and replace election cycle after election cycle, the Republican Party never bothered to come up with a replacement. Cohn again:
The incentive structure in conservative politics didn’t help, because it rewarded the ability to generate outrage rather than the ability to deliver changes in policy. Power had been shifting more and more to the party’s most extreme and incendiary voices, whose great skill was in landing appearances on Hannity, not providing for their constituents. Never was that more apparent than in 2013, when DeMint, Senator Ted Cruz of Texas, and some House conservatives pushed Republicans into shutting down the government in an attempt to “defund” the Affordable Care Act that even many conservative Republicans understood had no chance of succeeding.
. . .
Republicans remain focused on, and quite skilled at, delivering outrage to their supporters. They continue to show no enthusiasm for passing laws, on health care or anything else for that matter. Over the past few weeks, as Democrats passed that groundbreaking COVID-19 relief initiative, Republicans have put most of their energy into making arguments about “cancel culture.” And although Democrats are already moving on to other pieces of legislation, including plans for infrastructure, a minimum-wage increase, and immigration reform, the most concrete thing on the Republican agenda is talk of reviving a half-dozen Dr. Seuss books that the late children’s author’s estate stopped printing because they contained racist imagery.
Apart from tax cuts for corporations and the one-percent at the national level, and voter suppression and gerrymandering to ensure minority rule at the state level, Republicans don't have much to offer by way of an agenda. They don't have a solution for the uninsured. They don’t have a plan to prevent catastrophic medical costs from bankrupting middle and working class families. Truth be told, apart from angry rhetoric, Republicans have nothing to offer regarding Dr. Seuss's oeuvre. There is no public policy agenda to solve the 'problem' Republicans are railing about.
Outrage may win elections. It won't pass laws. It won't create public policy. It won't offer solutions for the American people.