On one end of the spectrum, you have the 25 year old single dude who works for a big company. He pays $60 every two weeks for his PPO and doesn't understand what the big deal is. Can people really not afford $60 every two weeks? He votes Republican because he's a maker, not a taker, and he wants a tax cut. He fundamentally misunderstands the nature of his coverage: his employer pays 80% (or 100%!) of his premium.

On the other end of the spectrum, you have a family of five that makes too much money to qualify for a subsidy. They live in a red state that didn't expand Medicaid, uses the federally-managed exchange, and suffers from a lack of competition because there's only one insurer on that exchange. An HDHP for the family would cost $1,300/mo, which they can't afford, so they pay the penalty and go without insurance. They vote Republican because as they see it the government is forcing them to buy something they can't afford, and they want it to be better... or at least go back to the way it was.

A lot of people and families had plans and doctors they liked before the ACA was passed, and one of two things happened:

1. because year-over-year premium increases are regulated by the government per the ACA, insurers were forced to make their plans more efficient by reducing the size of their networks in one way or another. This meant that a lot of people lost access to their doctors and had to find another, often having to travel further and/or wait longer to see their new doctor.

2. they had terrible insurance before the ACA was passed, but didn't realize it. Perhaps they had unreasonably high deductibles, or access to few essential services, or ridiculously low lifetime limits, or punitive coinsurance rates, or... Perhaps they'd refuse to cover something because it was a "preexisting condition." Perhaps they'd drop you mid-treatment, making it impossible to get further treatment without going into severe debt. This insurance wouldn't have been much use to anyone in the event of cancer, or a heart attack, or a broken leg, but they were paying the premiums anyway, and it sure helped them feel insured. ACA made all of these practices illegal, or at least put some controls on them to ensure a baseline quality of insurance. These plans went away or became as expensive as other plans.

These people vote Republican because from their point of view ACA took away their plans and their doctors, and Obama had stupidly promised them that wouldn't happen. They had it good, or so they thought, and it was taken away from them.

Everyone else is experiencing rising deductibles and premiums with no end in sight. What most people fail to realize is that deductibles and premiums would be rising with or without ACA—as they were before the passage of ACA—at a greater rate! ACA bent the curve, so they're still increasing, but less so. Yes, your insurance cost $300/mo last year, and it costs $400/mo this year, but how much would it cost if ACA hadn't been passed seven years ago? Would you even be able to get insurance? Do you or a family member have a preexisting condition? Our minds aren't wired to think like this, though... all we see is a higher bill and want someone to blame, so we vote Republican.

I could go on. ACA did a lot, but it didn't do enough to encourage competition and control costs. Clearly. A public option and "death panels" would have helped a lot, but of course these were dropped to encourage bipartisan support for the bill... which it didn't get. Oh well.