The Affordable Care Act was enacted into American law in 2014, and like most things that have certain specific intentions, there are always going to be in a country such as America certain unexpected outcomes, to which the Affordable Care Act suffers from greatly. For instance, the middle class carries America, because they are the only class in America that carries the full weight of being an American, with no special privileges granted to them, and no special subsidies provided for them. Not too surprisingly, the Affordable Care Act, has been particularly pernicious to the middle class, as for single people the phase out of subsidy for health care rests at $45,960 and for families of four it's at $94,200; and because the Affordable Care Act phase out does not take into account whether you live in a community with a high cost of living or not, this phase out is especially troubling for those that do.
The thing about employers is that they are in almost every instant in the business of making a profit, and therefore make it policy to pay especial attention to all phases of their ledger book, which would include expenses, and healthcare premium expenses that are paid for by the employer is one of those expenses that makes a material difference to a company's bottom line. This means, when health care premiums rise, and they always seem to rise, those costs either have to be shared between employer and employee, absorbed by the employer, or just passed on to the employee. The real world upshot of all this is that the employee in many companies is suffering the dual problem of having their premium responsibility that is deducted from their paycheck for healthcare increased, while on the other hand, their health coverage has gotten vastly skimpier, unless they opt in to a more comprehensive coverage, if offered, which will cost the employee considerably more in expense. This means in a nutshell, that the affordability of healthcare for the middle class has gotten appreciably worse since the passage of the Affordable Care Act.
The problem with mandates and regulations that go on for pages and pages and pages, and further that the legislators don't even bother reading, is that America has a multitude of highly trained lawyers, accountants, and special interest groups that do pay close attention to words and their meaning, and consequently make sure that in one form or another, employers will come out alright, as opposed to the real payers into the system, the middle class employees. The sad thing is many employees do not know even how bad or how weak their company health insurance is, till they go on to utilize it for an emergency, something unexpected, or whatever, whereupon they find out that their coverage for necessary treatment is something far less than ideal.
The way our healthcare system works currently is a federal law is passed, the employer receives a new mandate, figures out how to manage and manipulate that mandate so that it is business pretty much as usual for them, and passes onto the employee the real impact of such legislation, which, for the middle class, means lower net pay, higher deductibles, and the shouldering of the burden of taking on more responsibility for their healthcare as well as footing the bill for it.