Until Obamacare came into effect being forced into purchasing healthcare insurance was an alien concept for Americans. The new paradigm is they still must be required to have insurance but with different rules. Originally the Republicans wanted to repeal Obamacare, then they switched to reform or replace so that big pharma and insurance companies would remain quids in whilst denying the right of anyone not to have insurance for their own health without being penalised in the form of fines. The US used to be all about individualism but has gradually become more collectivist.