I would think to really reduce costs we could stretch out subsidies for insurance purchase, and maybe reduce them. The mandate for required purchases could also be delayed. I don’t think the bill does enough to reduce costs.
Making the system mostly focused on guaranteed catastrophic coverage might also make sense, though this would tend to drive people into the emergency room.
All this said, I think we owe Barak Obama a debt for getting a health insurance law passed, even if we have to amend it substantially.