The RAND Corporation released a report comparing the health care reform law to a myriad of alternatives to determine if there was a way to craft legislation that resulted in more individuals with insurance coverage at a lower cost to the government.  The authors found that only a few such options existed, and that they are not politically feasible because they involve unpopular changes such as higher penalties, lower subsidies and a smaller expansion of Medicaid. 

McGlynn, E., et. al.  (2010).  Could we have covered more people at less cost? Technically, yes; politically, probably not.  Health Affairs,  1142-1146.  doi: 10.1377/hlthaff.2010.0433.  http://content.healthaffairs.org/cgi/content/abstract/29/6/1142

Authors: Elizabeth A. McGlynn, Amado Cordova, Jeffrey Wasserman and Federico Girosi