Who can, and How can, the ACA be made to work for the American people

With all the goings on about the ACA bad, where is the conversation as to What should be done to fix it?

Where are the people to have the discussion and solve the problem, once and for all? Is it a minor tweek? - Is it the Insurance companies? Is it Big Pharma?

Just me thinking out loud...the solution is above my paygrade, and seems to me we have been paying the wrong people in congress for 8+ years to find the answers...