The ACA just piled onto the clusterfuck we already have. At a federal level we've already got Medicare, Medicaid, Tricare, and now the ACA. Within medicare we have "parts" A through D that offer a bunch of intermingled benefits. Even when someone has medicare it's a huge fucking pain in the ass to figure out which "part" to bill and if you send it to the wrong one they won't pay.

Many states have their own programs as well.

It's a gaint fucking mess they need to cut the shit and just throw everyone on Medicaid