The ACA was only ever meant to be a first step. It was never intended to be the end goal. The Republicans gutting the individual mandate is what stole that momentum because it leaves simply being uninsured as an unfortunately viable financial option for enough people that it reduced pressure to reform the rest of the system.

The end goal is single payer. But it's difficult to the point of bordering on impossible to shift from what we had instantly into single payer in the third most populous country on the planet. It's estimated that single payer will put nearly 400,000 private insurance middle-people out of jobs. That's not a negligible problem. We're going to need a way to address that in the process of making the shift.

The ACA open markets have allowed me to leave jobs that I otherwise would not have been able to leave because I can't afford to go 30-90 days without health insurance. That open market didn't even exist when I was a young adult 20 years ago. Insurance gaps between jobs were simply a fact of life that a lot of people couldn't abide