Scully, who has spent the last 30-some years oscillating between government and the private sector, is hoping to be his own best proof of the Obamacare gold mine. As a principal health policy adviser under President George H. W. Bush, he helped formulate many of those past Republican initiatives — like the shift to private-insurance programs — that Obamacare has put into law. Under George W. Bush, he ran the Centers for Medicare and Medicaid Services and oversaw a host of proto-Obamacare reforms, like Medicare Part D, which introduced competition into the government-supported health care market. After leaving C.M.S. in 2004, Scully began working simultaneously at Welsh, Carson, Anderson & Stowe, a leading health care private equity firm, and Alston & Bird, a law firm and health care lobbying organization. When the Affordable Care Act became law in 2010, he found himself in the rare position of being a lobbyist, private equity executive and former government health care official with access to a serious amount of capital. During the past three years, as other Republicans have tried to overturn Obamacare, Scully searched for a way to make a killing from it.

A couple of years ago, Scully identified his best bet. NaviHealth, the company he co-founded, is designed to streamline an enormous but often overlooked corner of the health care market that, many studies conclude, is the most financially wasteful: post-acute care, or the treatment of patients (mostly seniors) after hospitalization for surgery or serious illness. NaviHealth relies on complex analytical software and a vast medical staff (it has about 175 employees) to offer better post-acute care at lower cost. By that September afternoon, Scully and his partners had already raised $35 million to build NaviHealth, which he expected to be profitable in one month. If all went according to plan, NaviHealth would be just the first of many billion-dollar companies built around the Affordable Care Act. Scully could demonstrate for countless other investors how to become their very own Obamacare billionaires.

Scully wrapped up his speech on a personal note. As a Republican, he said, he was ambivalent about the Affordable Care Act. He liked the market-driven private-insurance exchanges, but he detested that the law called for hundreds of billions of dollars in future subsidies to help Americans, including certain families earning up to about $95,000, buy insurance. The rapid transfer of so much money from other parts of the economy could have a negative overall effect. “It’s way too much money, way too fast,” Scully said. “But it’s going to be great for you investors.”

Most of the attention surrounding the Affordable Care Act has focused on a single aspect of the law. Even the House Republicans’ recent effort to dismantle it — and the major computer malfunctions that botched its rollout — have been funneled into a debate about the expansion of insurance coverage. (Before the technological setbacks, the Congressional Budget Office expected up to 16 million people, including Medicaid subscribers, to sign up for insurance by the end of 2014.) In many ways, however, Obamacare is less about health care than it is about economics. Medical costs have outpaced inflation for decades, and they are expected to continue to grow significantly over the coming years. The C.B.O. has indicated that those costs, which are expected to nearly double as a percentage of the overall economy by 2038, are by far the largest contributor to the country’s long-term deficit. “Health reform was not just about covering the uninsured,” Elizabeth Fowler, a former staff member for Senator Max Baucus of Montana and a chief architect of the Affordable Care Act, told me. It was “about this twin goal of access and finding ways to reduce the rate of growth in health spending. Everybody is focused on the coverage angle, but the changes in the law designed to address cost could be a bigger and longer-lasting change.”

The economic assumption inherent in the law is that the government can cut costs by shifting the incentives of health care providers. The existing system is built around a so-called fee-for-service model, in which doctors, hospitals and other practitioners are paid procedure by procedure. The Affordable Care Act seeks to pivot toward what’s called a value-based model, one in which plans and providers compete on price and quality rather than volume. “Before the Affordable Care Act, hospitals and other providers were paid almost solely based on how much work they did, not on how well they did,” Jonathan Blum, the principal deputy administrator of the Centers for Medicare and Medicaid Services, told me.