The primary mistake you make here is comparing the ACA to the Canadian system. There is no comparison. In the first place the Canadian system is now national. Ours isn't and I doubt given the contingencies of the various differences in ideological constructions based on the regional differences in America, the South being absolutely nuts, it ever will be. We finally have something like universal veterans benefits but the way they are administered varies drastically from region to region and when it comes Medicare and Medicaid, it is probably much, much, worse. In Canada everyone is covered. In America we are still a long way from that. This mostly will cover many workers eventually but the extremely poor will still be left out I think. And more so depending on where the poor live. Texas and Florida the states with the largest pools of people without health insurance, the efforts are miniscule; they just don't want to cover anymore people!