Blame conservatives. Most are low-effort thinkers who vote for the candidate who panders, who serves them ideas which are easy to believe rather than those which are hard to understand regardless of how much more valuable are the latter than the former.
Really? Conservatives are responsible for the sorry mess of PPACA? Not the reps who voted for it?
Substantially, yes. Had not they shown themselves so willing to obstruct and obfuscate, we could have gotten a far better solution to our health care access problem. Note, though, I'm not blaming this only on Republicans. Conservative Democrats are as much to blame as the Republicans.