> The only major change in the last decade was Obamacare which is remarkably similar to the system passed under a the Republican Governorship of Mitt Romney.

Which itself was a state level implementation of a program the insurance industry and national Republicans were talking up as an alternative in the 90s when, i the wake of the failure of Clinton’s healthcare reform, it seemed there was enough residual demand for something to be done in that regard nationally that they thought they needed to bring something to the table.