Sustainable is an odd term to use in this case. The ACA needs work, all complex legislation does, especially when it effects a public policy initiative like healthcare. But rather than actually look at the law, see where it needed improvements and working toward that end the GOP decided it was a good idea to have 50 repeal votes and run on repealing it.
Well, as it transpires people like having healthcare and they aren't going to give it up without a huge fight. So now what a GOPer to do ? You can't repeal it and you can't try to improve it without tinkering with it and the 40 members of the Freedom Caucus will have none of that, so they're stuck. As near as I can tell the only way around all this is to actually work with the Dems on improving the ACA. Not repeal, not replace, improve. And I'm sorry but I don't think Ryan is smart enough nor a good enough leader to pull that off. Trump, on the other hand is both manipulable and really annoyed with his own party. I see an opening for the Dems here
True is a funny word to use in this case. When Obama said it it was, in fact, a true statement. There was nothing in the ACA that would stop you from keeping your doctor. But neither he nor the ACA nor Congress could have foreseen the insurance companies actions on the exchanges. Basically the insurance companies goofed with the policies (as is their right and privilege as private companies) to screw up everyone's plans in an attempt to keep their profits as high as possible. But I think we have to come to grips with the fact the insurers did that to you, not the ACA per se.
As far premiums going down is concerned, they have. Just not for most people. Premiums have gone down for people with individual polices when compared to like polices before the ACA. Admittedly that's a small number of people. But more to the point: Health care insurance costs are growing at a much lower rate now then before the ACA and at a lower rate then the CBO predicted in 2010. Also healthcare costs themselves are also growing much slower and we're collectively going to save 600 billion (yes over half a trillion) dollars in healthcare costs by 2020 or maybe 2025 I can't remember because of the ACA.
Now, I just had to write 2 complicated paragraphs to answer your bumper stick soundbite question. And that was part of the problem for Obama and the Dems and is now the problem for the GOP and Trump. This is a big, hard, complex, boring, numbers oriented, statistically derived issue involving a piece of legislation that only one person I know of understands.
Strategy is an odd word to use for this. If you're in power and chose to do nothing all you're doing is letting the other side take the initiative. Trust me on this the Dems are not going to sit idly by while you ignore the problems with the ACA. They will start making proposals to improve the ACA and doing nothing on your part will not be good for you.
The Republicans are in the same position. They can't repeal the ACA and they can't leave it alone. The Dems are already putting forth the idea of Medicare as an option in the exchanges and lowering the Medicare age to 62, both ideas that WILL lower premiums by taking older people out of the private insurance market . That's going to be the conversation driver from now on, not how do we rid ourselves of the ACA.
The GOP has lost the initiative on this by being unable to take any action on their own.