Remember, this is a socialist plan, and as such it is designed for everyone who is able to help out everyone else. The prices are resource, not risk, based. If you can pay, you have to pay for everyone. As some other countries have proven, a single payer system can work and provide both quality and cost effective health care. One problem with our system has been that the financing is fragmented, resulting in a lot of duplication of administration and record keeping, not to mention billing and payment. ACA will not help that, since it does not eliminate any of the current financing systems and, in fact, adds another layer of administration for probably millions of people. Therefore, since it provides no efficiencies there is really no way for the ACA to save anyone money. Its expanded coverage in many areas will actually increase costs.
A large portion of the healthcare providers in this country are investor-owned hospitals, clinics, and specialty providers. That for-profit portion of the system came about, oddly enough, thanks to Medicare and Medicaid. Before those programs, hospitals were money losers, not just nonprofit. With the surety of payment from the government, the hospital business became a potential profit area. For profit hospitals also brought to the market new efficiencies, such that only the profit motive can produce. At the same time, they brought a new kind of customer service to health care, although in most cases, the "customers" they courted were physicians who would admit patients to their hospitals.
The problem remains, though, that there are so many payers--insurance companies, government agencies, individuals, unions--that there are thousands of administrative offices and departments, all adding cost but no efficiency to the system. Hospitals and other providers don't know what they're charging much of the time, since their posted prices are not paid by anyone. I personally had bills for a hospital, hospital-based physicians, labs, etc. that totaled around $18,000, but after all the adjustments, the actual bills were less than a third of that before any payments were applied. It's worse than buying a car! OK, maybe not worse, but almost as bad.
So, the ACA, if it were to take the place of Medicare, Medicaid, and every health insurance company in the U.S., might in fact be able to save money, by virtue of being a single payer finance system. And guess what? That is exactly the intent of the people behind the ACA. They know it won't work as is, but once in place it will never go away or even reduce in size. It will just grow and grow until it becomes the national health plan that Hillary Clinton was trying to build in the 1990's.
Of course, the other piece of the financing pie that has to suffer is the de facto subsidy of the rest of the world's prescription drugs. The newly developed drugs that cost so much here--because the R&D has to be paid by someone--cost pennies on the dollar other places where the drug companies sell the drugs. Why? Because that's all they'll pay. And if the U.S. consumers pay the R&D, then the exports have only manufacturing cost to cover. Yes, we have been getting the wrong end of that stick forever. Think of it as stealth foreign aid to the rest of the world. Well, when our new single payer steps in and says this new drug can only be reimbursed $x, then there's not enough to make it work developing new drugs...or the rest of the world will have to bear its share of the R&D cost. Imagine that. Eventually, the ACA is going to drive up health care costs in other countries.
Sorry, I ranted again. There is potential for the ACA to be long term beneficial, but we have way too many crooks in government for that to happen.