In December of 2009, President Obama proudly stated, “Whatever ideas exist in terms of bending the cost curve and starting to reduce costs for families, businesses, and government, those elements are in this bill.” Three months later, the Patient Protection and Affordable Care Act (ACA), also known as ObamaCare, was signed into law. Yet, a 2013 report revealed future health care spending would increase significantly. And increase it did.

According to the Kaiser Family Foundation (KFF), the average yearly cost for family coverage in 2009 was just under $13,400. Today’s average? $22,463. President Obama claimed his bill would “cut the cost of a typical family’s premium by up to $2,500 a year.” It seems his words were no more than a soundbite meant to sell people on the idea of something better. And boy, did the U.S. buy!

Pundits and ACA supporters alike claim numbers don’t lie, praising the ACA for historically increasing the number of insured Americans. American Community Survey results support such claims, stating 299 million Americans had health insurance in 2021, the most ever. Despite this, per Gallup, a record-high percentage of Americans say they delayed medical care within the past year because they could not afford it. Additionally, Kaiser states over 100 million people in the U.S. are experiencing medical debt, while the Centers for Medicare & Medicaid Services report annual health care costs are now about $13,000 per person – in addition to the cost of insurance.

Indeed, numbers don’t lie.

If Americans are to live with health care that does not financially strangle us, then the ACA needs a significant overhaul. Does the American public have an interest in such changes? Absolutely: 76% of Americans are dissatisfied with the cost of health care in the U.S., according to Gallup, while Pew Research Center found “reducing health care costs” is a top priority that Americans want the president and Congress to address.

A seemingly simple solution is a single payer “Medicare for All” system, though the public’s attitudes are complicated. Gallup shows 38% of Americans believe the government’s role is to ensure that everyone has health care coverage and the government should run the system, while 35% believe the nation should use a private insurance system and it is not the government’s role to ensure health care for all, and 18% believe the government should ensure that everyone has insurance, but that this be accomplished through private insurance. It is clear most Americans recognize that government has a role in expanding health insurance coverage, though many are ambivalent about satisfying that role with a government-regulated system.

Whether single payer or another approach, of particular importance to any health care reform effort is the American people themselves, and how they feel about health care cost, quality, and access. The people are the consumers of health care and the target toward whom all this effort ought to be focused. Therefore, it only makes sense to work with them by including the attitudes of the very people and constituents that policymakers claim to serve.

If and when a new committee, task force, or advisory group of policymakers, health care leaders, and other experts is put together to advance health care reform once more, the primary concern must be involving the American people themselves in the process. As is the case with any major societal reform, the plan ultimately needs to work in the real world. Health care should be no different.

Perhaps the most notable good from the ACA are the protections for people with pre-existing medical conditions, something the public and majority of Democrats, Republicans, and independents agree is “very important” to keep in place, according to data tied to KFF’s Health Tracking Poll. The U.S. Department of Health and Human Services (HHS) states over 133 million people with pre-existing conditions have been protected from coverage denial because of the ACA’s provisions.

Reflecting on cost, I would grade the ACA with a less than respectable “C,” with the good of these provisions being its saving grace. Let us not throw away the baby with the bathwater just yet. Though above all, one thing remains clear: ACA supporters fail to recognize that increased access to health insurance does not simply equal access to affordable health care services. Surely, the American people deserve better.

Brian Gomez of Prospect is a Master of Public Health student.