Obamacare didn't fix US healthcare, although it certainly provided insurance for a lot of people who otherwise wouldn't have it. At the same time, it did make life harder for certain groups of people at certain income levels, who ended up paying a chunk of their income into it (interestingly, MSN just had a story about this, claiming about 9 million Americans fall into that income level). So, without Obamacare, these people wouldn't have their incomes so badly affected... but there would be millions more who wouldn't have any kind of coverage. IIRC, the usual claim is that 20 million Americans have insurance through Obamacare. If the ACA hadn't been created, then a big topic of conversation in political circles would be the growing numbers of uninsured people. Hell, it was a big topic of conversation before Obamacare, as older members of ah.com could tell you. There might even be increasing calls for some kind of UHC, as more and more stories about 'this person died because he couldn't get health care' circulated...