The long term success of the ACA is predicated on getting large numbers of young healthy people, making a decent wage, to sign up, so as to bring more money into the system, and minimize the expenses. Instead, the majority of those signing up are the poorer people who require substantial subsidizes to get insurance. Many of the better off young are foregoing this insurance, and opting instead to pay the penalties. Without the subsidies, and lacking employer coverage, these young people face costs in the many thousands per year to get health insurance...even under the ACA exchanges. For them, the penalties, and the occasional out of pocket expenses if they do need to see a doctor are quite a bit less than buying insurance. So the Net gain, or in this case, "reduction" in health care costs, is going to be very difficult to attain. It may all work out in the long run, but I seriously doubt it. I see nothing but continuing rising costs for health care that far outstrip inflation and wages....no matter what kind of spin the government tries to put on this program.