Regardless of whether one agrees with the intent of the Act, it is extremely poorly written and the longer we go the more this is coming to light. But even getting true believers to admit this much is a struggle.
Part of the problem was that the architects of the Act simply could not fathom that not all States or citizens would submit as they envisioned. They saw themselves as liberators who would be showered with flowers and kisses and ticker tape parades.
But it goes far deeper than that. For if they had looked around them and truly understood the level unease for their whole endeavor the Act would have been written in far more retaliatory and totalitarian way than it is already. The evidence could not have been more clear, yet the arrogant certainty surrounding their purpose clouded their judgment so much that they could not even muster the required level of totalitarianism required to fulfill it. As a result, even the totalitarianism in the Act is half-assed. (The Supreme Court even stunned them by unmandating the Medicaid expansions mandate. They were so stunned by this the media could scarcely mention it for over a year).
It’s not that they cannot tolerate dissent and disagreement (that would be one thing and would be at least logical). They simply cannot fathom it. And so, to cover up their own cluelessness and fecklessness about how poorly crafted the Act is all they have left is to attack people who merely point it out as “haters” etc.
This is akin to flailing your arms around uselessly while drowning after you arrogantly assumed that the ocean is perfectly safe.
This is to be expected, considering how often they seem to tell each other they can walk on water.