Three years ago I wrote a piece here entitled Obamacare and the Coming (Not Again?) Wealth Transfer that provided a resume of the then current, reality based take on the obomination called Obamacare. What was obvious then about the future of the Unaffordable Care Act has played out in its realization. The cruel, repetitive, neoliberal joke has been played on the American public, leaving the fat cats laughing all the way to their offshore accounts.  The excerpt below comes from a wonderfully comprehensive look at the Unaffordable Care Act written by Howard Waitzkin and Ida Hellander in a piece for the Monthly Review entitled The Neoliberal Model Comes Home to Roost in the United States—If We Let It

Excerpt: "Abundant data substantiate that the failure of Obamacare has become nearly inevitable. Even after the ACA is fully implemented, more than one-half of the previously uninsured population will remain uninsured—at least 27 million people, according to the non-partisan Congressional Budget Office—and at least twice that number will remain underinsured. Due to high deductibles (about $10,000 for a family bronze plan and $6,000 for silver) and co-payments, coverage under Obamacare has become unusable for many individuals and families, and employer-sponsored coverage is headed in the same direction. Private insurance generally produces administrative expenses about eight times higher than public administration; administrative waste has increased even more under Obamacare, and remains much higher than in other capitalist countries with national health programs. These administrative expenditures pay for activities like marketing, billing, denials of claims, processing copayments and deductibles, exorbitant salaries and deferred income for executives (sometimes more than $30 million per year), profits, and dividends for corporate shareholders. The overall costs of the health system under Obamacare are projected to rise from 17.4 percent of GDP in 2013 to 19.6 percent in 2022. A conservative projection shows that premiums and out-of-pocket expenditures for the average family will equal half of the average family income by 2019 and the full average family income itself by 2029."

All talk of somehow "building" on this terrible legislation is so much bunkum.  Put whipped cream and a cherry on a turd and you still have a turd.