It's easy to think of the Affordable Care Act as a federal program so big that it is impregnable and impervious to change. But that would be wrong. In fact, there are provisions in the ACA that allow states to change major parts of the law.
Many Americans are learning about health insurance for the first time, and others are adapting to changes. One area that seems to be ever-changing is "networks," as in doctors and hospitals "in network" and "out of network."
When looking at the forces in our economy that are determinative of our ability to research, create, and propagate the technologies that save or improve lives, there really are no special reference points that distinguish the 1% from the 99%.