The impression I've got from snippets of world news is that the republicans fought tooth and nail to block these reforms at all, so the eventual compromise in the end is basically "business as usual".
A big part of the problem imo is how vast the bill is. A lot of the reforms would have passed bipartisan easily, but they were attached to huge sticking points that would never pass with bipartisan support. Generally people like to ignore the problems with the bill under the excuse of, "...but healthcare is better than no healthcare!" and that's the kind of thinking that ends up 10 years later with you wondering why politicians were so stupid to pass a bill that essentially makes health insurance companies both incredibly powerful and on a crash course for drastic change or failure.
The simple answer to why things like the ACA are generally bad is because a 'mostly good' philosophy is not a good philosophy for legislating.
edit: And personally I would prefer most of the things offerred by the ACA to be handled at the state level. I am not a fan of how much responsibility we give the federal government instead of the state government. If a state government has a failure you can usually fix it in weeks/months and if it's really bad you can move. If a federal government has a failure the fixes usually take months/years and it's not nearly as easy to relocate to a new country as to a new county.