Closer to universal health care
The health care act gets US residents closer to universal health care. Still, there are plenty of people who even with this act do not get access to care, either because of shortcomings in the law or by religious doctrine that forces health care providers to close shop.
Other countries have universal health care and mandatory health care insurance for about 100 years and they fared quite well with that approach. They also have no artificial restrictions in place as the US has, mainly that healt insurances are not allowed to operate across state borders. They may appear under the same name, but they cannot sell the same plan across the nation. Further, there are many variations in billing codes and rules and simplifying those into a nationwide standard would make billing for providers much easier. Currently, they need to hire several people to do nothing else than submit bills to insurance companies. Generally, there is a far to big administrative overhead in health care. That drives cost without improving service. The same can also be noticed at universities, where academic staff is about the same as ten years ago while administration more than doubled.
As far as healthcare.gov is concerned, that project was doomed to fail from the get go due to the federal procurement rules that Congress put in place over the decades. In a well meant "spread the wealth" approach every federal project has to be awarded to multiple companies. In this case it was over 50 entities involved and none of them were in charge for the whole project nor was there anyone assigned with project management tasks having the experience with such large projects. Let's be fair, healthcare.gov was one of the largest IT projects ever put together. Many smaller projects are not ready even after more time.
Congress needs to change procurement rules. For that they can - again - look at the forward thinkers in Europe. For example, Great Britain had a few disasters of the same kind, but they then changed the way how projects are awarded. There are now much less entities involved and one of them is clearly tasked with project lead and project management. Since then projects get completed, work as expected, and more often than not are on time and on budget if not even done faster and cheaper. In the current constellation Congress is more interested in blaming and bashing rather than fixing problems. As long as the majority says no to everything that will not change. In that regards I see no hope, there are too many who focus solely on ideology and personal gain than actually doing the job they were elected for.