I'm just tired of the "ACA was watered down from what Obama really wanted because of compromises made to the GOP" meme. It's not true. Compromises were made to garner votes, but not to garner GOP votes.
I think you need to go back and look at how it all went down. Obama gets into office preaching a new kind of governing and makes healthcare reform a priority. The Minnesota Senate race was still going through recounts so there were 59 Democratic senators, counting Lieberman. Some of the Dems were squishy. It also seemed at the time like maybe they would be able to get a handful of Republican votes like Olympia Snowe or Susan Collins.
Obama really wanted to stamp this as a somewhat bipartisan achievement. So there definitely was significant engagement with Republicans in the early stages, both because of the possibility that their votes would be needed (if the Minnesota recount went poorly or if a few Democrats voted against), and for the optics of getting at least some Republicans on board. So the general framework started getting worked out under that premise.
It took a while before Al Franken won the recount, and it also took a while before it became evident that that they weren't going to get any Republican votes at all on this. By that time the health care discussions had been ongoing for months and there were already issues with Senator Byrd and Senator Kennedy's health. Scrapping everything that had been discussed and starting from scratch wasn't a very viable option. So they cut some shady deals with the few Democrats still holding out and pushed what they had through the Senate while Kennedy and Byrd were still able to vote. It wasn't obvious that version was going to end up being the law, and the House wasn't happy with it, but then Kennedy died and Scott Brown got elected, so passing a new version in the Senate became impossible and they just went with what they had.