It's really tough to say at this juncture. The success of the ACA is going to rely very, very heavily on this first open enrollment period and how many people sign up. The traffic numbers are obviously very good so far, but how that translates into actual customers remains to be seen. If the CBO's estimates turn out to be right, the ACA should function reasonably well from a revenue/cost perspective. If the actual numbers fall short of that, it's going to be a rocky road fiscally until year 3 or so when the larger mandate fees kick in.

As for advice to Washington, I personally feel that one of the larger mistakes the Democrats have made is one of message. For most, the the term "Obamacare" is synonymous with health insurance and health insurance alone, when in actuality the law is more far reaching than that and several stipulations of the law have already gone into place that I think are going to have positive effects and are being overlooked. For instance: 

• The FDA can now legally approve more generic pharmaceuticals, which will increase competition and drive prices down. The FDA has always approved generic pharmaceuticals. What specifically has changed?
• It places a huge emphasis on preventative care. If you're going for a mammogram or colonoscopy, you no longer will be paying a copay for that visit. Who will be paying then? Is it "free"?
• It taxes things like tanning booths, which lead to very high rates of skin cancer. I thought you were an insurance guy, not a doctor. I guess raising taxes should be good for small businesses.
• It removes lifetime limits on insurance payouts. These limits were negotiated buy the insurance provider and the customer. Now, that is no longer in the hands of the insurance company. So who pays for this?
• Insurers can't drop patients for getting sick or pregnant or otherwise incurring medical costs, which happened far too regularly before. Perhaps it did, but I'm not familiar with many stories to that effect. I question just how "common" it was. I certainly have a personal example where coverage WAS NOT dropped even though insurance companies changed hands several times throughout a pre-existing condition.

As far as more pie in the sky suggestions that aren't directly linked to ACA but I personally would prefer, like I said, a single payer system akin to the system in Canada or England is, I think, the inevitable conclusion of the healthcare debate in the US. The GOP actually finds itself in a really odd place right now, because they are simultaneously the party of small government (true) and the party of big business (not exclusively true--many of the darlings on Wall Street are quite cozy with the Democrats), but can't be both in any debate over a single payer system. The decoupling of health insurance and employers would result in huge cost savings for American businesses, but would also result in a substantial growth in the size of the federal government (It wouldn't have to unless the federal government continues to increase their control of the market, which the "single-payer" model does.)  They're going to have to reconcile one of those positions, because I just don't see how "15% of our population shouldn't have access to healthcare" (Define "access to healthcare") is a winning strategy for them. Going forward, any repeal of the ACA is going to have to be accompanied by a solution and as of yet, the GOP haven't presented anything outside of Darrell Issa's plan, which is actually just the ACA all over again.