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Healthcare was barely even discussed during the last election. Trump has no plans to improve it and Harris didn't campaign on it. We can't just directly vote for laws, we have to elect leaders that would write a bill and vote for it. And pretty much everyone in Congress is bought out by Big Pharma, which has more money than god so it buys elections.
tl;dr the USA is not really a democracy, just as the founding fathers intended.
Even I know that Trump did his best to sabotage the ACA. It's not a secret. Just vote for the direct opposite of that fuck.
Try explaining that to the typical Republican party voter, though. All they know is "Obamacare BAD!" because that's the message that has been pumped into their brains non-stop for the last 10 years. When you actually start explaining the specific things that the ACA established they'll say, "Oh yeah, that seems like a really good thing, we should do that!" They don't understand that ACA and Obamacare are the same thing.
We are inundated with these sort of low-information voters who don't understand how their representatives are literally screwing them over while blaming the other side for all their woes.