The Affordable Care Act is the biggest non tax cut legislation of the previous 30 years.
Which recent administration cut federal spending?
...and I don't have anything against cutting spending. In fact, actually think Reagan did the right thing in using this tool as well as deregulation to end stagflation. But it seems like cutting & spending should be based on the situation and for 2008, spending seemed the right course of action.
Rubinomics under Clinton was lower interest rates and spending cuts/deficit reduction.
The fact that it was this big and this hard to get and with this many compromises against consumer interest, speaks more of the disfunction of the USA government at the time then it does about the value of that legislation.
This fight not about the dysfunction of the USA government at the time, it's about a fight over the structure of the USA as it was founded. There have always been strong political forces trying to dismantle all "common sense" features of the welfare state, who have convinced the masses to vote against their own interests out of the American Dream of rugged individualism.
This is in contrast to the unique decentralized communitarian history of America with community activism, charities, NGOs and nonprofits filling the social holes between the government and private enterprise. The current healthcare system evolved out of this, and gradually received more patchwork of private and government involvement (Medicare/medicaid, and the ACA) which why it's an expensive mess. Most European countries post WW2 had a chance to design something more efficient and didn't centralized insurance as a threat to liberty.
But in essence the most revolutionary part of the ACA was regulating how health insurance companies sell insurance to their costumers, i.e. consumer protection. There were other aspects of the ACA, like subsidies to low income families etc. which weren’t consumer protection, but the regulations about how insurance is priced and sold most definitely were. And these regulations were very basic and common sense kind for any consumer products, stuff like don’t abuse your customer’s health situation with personalized premiums etc.
I say that this should not be a consumer market because private health insurance are inherently consumer hostile, and cannot be sold on the consumer markets without hurting the customers with unfair charges, etc.