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I don't think that the Democrats "focus on" the poor. Since Clinton and welfare reform, the opposite is true.
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The ACA was aimed primarily at the poor, focusing most on giving people without insurance a form of insurance. That covered some of the middle as well, but they weren't the target. As we heard a lot of times, the aim was to get the uninsured "on the rolls." Many of them had no money to pay at all, so they were subsidized in various ways.
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Small businesses tend to be Republican, fwiw. But the ACA helped small businesses, which have less leverage to negotiate for health care than large business.
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YMMV, but it's still like popcorn at the movie theater. The prices are still high. Only difference is they're not going up quite as much YOY.
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Health care is a middle-class problem too. The GOP has no health-care agenda at all. The Democrats have one. Which is better for average Americans and small businesses?
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If the aim of ACA were primarily making it cheaper for those who could pay something, rather than making it available to all, I'd agree the ACA was aimed at the middle class. But because it was aimed at making HC available to all, it had to focus most on getting money to pay for people who couldn't afford to pay much of anything. The dollars that went to them could have gone to the middle class person who could pay something but was struggling to do so.
There are of course social reasons to take that approach. But as I stated, you can't say the ACA benefited the middle class first or most.
I agree that the GOP has no plan for HC. It prefers to spend its deficit fueled dollars on the non-multiplying project of Tax Cuts for the Uber-Rich.
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Shorter Sebby: 'The major political parties are really the same, if you ignore the major domestic political accomplishment of the last Democratic President and don't think about the most important domestic policy issue of the last twelve years.'
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I don't think HC was the most important domestic policy issue. I think the most important domestic policy issue is the shrinking need for labor going forward and what we're going to do about it which only Trump and Yang have addressed. Trump by attempting to undo globalization and bring back manufacturing jobs, Yang by pushing forward universal basic income. I also have to give a shout-out to Bernie Sanders for at least highlighting that labor market reckoning, but of course, he didn't really have a plan. (Nor does Trump, really, but via his trade war, and now an unwelcome assist from Covid, there is some attempt to re-domesticate jobs that had gone elsewhere.)
