ACA is not Universal Health Coverage. So this would be different enough. And you don't need perpetual majority control, only sensible politicians for about a generation (like FDR/Truman/Eisenhower/JFK) to lock in a popular entitlement.
Sensible politicians? In the US? In this era? For a _generation_???
It was pretty close until republicans pulled back Medicaid.
FDR and "sensible" is always funny to me. The sensible politician that imprisoned Japanese Americans, destroying the lives of 120,000 of our fellow citizens.