From the beginning:
Cost sharing is an essential part of any insurance. They do it with auto insurance too. As such, nobody would be covered unless healthier people bought insurance. That's why a public option would have been the best plan instead of ACA.
It might have killed the private ins. industry, so Obama chose other avenues.
If you are going to force insurers to take people with pre existing conditions, you have to guarantee them remuneration for expected losses for the first few years. In theory, after about 5 years, losses should shrink as a healthier nation incurs fewer illnesses. That's why ACA added numerous preventive procedures without any extra OOP.
The taxpayer will ultimately pay for these losses as more and more uninsured become destitute under the weight of medical bills.
There is no easy solution. ACA was meant to be a foundation. Imagine what could have been, if Republicans actually worked to craft a better plan with Democrats?
the plan itself was the issue, creating insurance for those that wouldn't lift a finger to have it