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The Act was based upon the healthcare program passed previously in Massachusetts by a Republican Governor and initially developed by a conservative think tank, The Heritage Foundation. The Act became law in , with votes along political party lines all Republican members of the House of Representatives voted against the bill. Provisions of the Act included new regulations such as new minimum coverage requirements required coverage for pre-existing conditions, for example. As a consequence, many of the existing insurance plans for individual purchases did not meet minimum standards. Some insurance providers subsequently left different markets or raised premiums substantially. While the ACA added millions of Americans to the insured rolls, it has been less effective in cutting the increasing cost of healthcare for the average citizen. According to the Congressional Budget Office , the average premium paid by a family or a single person more than doubled between and , a rate exceeding growth in per capita income. The question is what, if anything, will replace the ACA?As the new Administration has discovered, reaching a political consensus on how best to provide Americans with high quality, accessible healthcare at a reasonable cost is difficult, if not impossible
