The ACA had dropped off the news radar for a little while. There were a number of other news items which took center stage; the fiscal cliff, sequester, etc. However, as the time lines for the various provisions of the ACA become relevant, this will again come back into the news. It is already happening.
I read my share of blogs and banter on the internet and associated with the NYT and WSJ. What I find interesting about what I read is there is amazing agreement between liberal and conservative voices regarding one thing relating to the ACA. They both appear to want it to fail miserably, albeit for different reasons. For conservatives, there is a desire to see this law fail to get to "I told you so moment". However, for liberals, failure is desirable because it will facilitate movement to where they wanted to end up all along; a single payer system. The functional details in the ACA were never particularly important since if they turned out to be dysfunctional the failure could easily be exploited to push the country to a single payer system.
As the events of 2013 unroll, it does not take a genius to see higher insurance rates and failures of the exchanges will be blamed on markets and insurance companies. That these "market based" entities are anything but market driven is a nuance which will be lost in the nanosecond attention span of the political class. The portions of the ACA that depend upon private insurance are going to fail miserably and we are moving toward a single payer system, sooner rather than later. When the exchanges fail to materialize the political right will claim government failure and the political left with claim market failure. The latter message, coupled with rhetoric about other market failures such as the housing industry, will hold sway.
In my estimation, the progressive statists are going to prevail. It is inevitable that we will end up with a single payer system. They hold all of the cards to win in the political realm, even with near term failure of the ACA. The problem is once they have achieved their political goals, where does that leave us in terms of fixing our health care mess? Having nominal coverage for an additional 10% of the population still leaves most of the structural problems of the current system in place. Who will set the prices for every health care service? Who will define what services are on the menu? Who will define how prices will change? What will be the provisions which will allow for change and disruptive innovation? Perhaps we can hire bureaucrats who have retired from Goskomtsen. They had plenty and experience in failure in administrative pricing and they have been unemployed since the Soviet Union fell.