I'd like to know what anyone disagrees with among the following claims.
1. The main goals of the ACA were (a) to increase coverage (by getting more people to sign up for insurance by taxing people who don't, by subsidizing low-income earners on the individual market, by expanding medicaid, and by making insurance accessible to those with pre-existing conditions), and (b) to "reduce" (i.e., slow the rate of growth of, or at least the rate of growth of the rate of growth of) overall spending on health care by ... some mechanisms I'm not familiar with.
2. The ACA is an unquestionable success on point (a). This isn't reasonably disputed, is it? Coverage is up; the percentage of uninsured is down.
3. I don't know how the ACA was supposed to reduce total spending on health care. I never thought it had a chance of happening. Sometime after its enactment, I recall reading that the rate of increases in costs was slowing. If true, that would be a partial success (but could also be explained by factors other than the ACA), but I didn't personally try to evaluate whether it was true, and even if it was, it may not have lasted. Basically, I don't know how effective the ACA was on point (b). I suspect it's hard to get a decent answer. Costs were increasing quite a bit before the ACA was passed and before it completely went into affect. I'm not aware of any blip in the trajectory of the curve, either upward or downward, after it went into effect. I mean, I'm sure total costs have gone up because coverage has gone up. But in terms of cost per unit of health care provided ... I have no idea. (In terms of cost per unit of good health outcomes, I assume that's gone up quite a bit because I don't think health outcomes are getting better.)
4. So bottom line, I'm fairly confident that the ACA has been effective in increasing coverage. I'm not at all confident, one way or the other, whether it's been effective or counterproductive at decreasing the rate of increase in healthcare costs per unit of health care provided.
5. I therefore have no strong reason to suspect that it hasn't done more good than harm on the whole, by at least getting more people covered.