The saddest thing, is that none of the trauma of ACA had to occur

[SoCalDem]

33. They ruled that individual states could opt-out of the medicaid expansion

and since the state-run exchanges were never truly mandatory, GOP governors/state legislatures could freeze their states out of ACA.. Florida's gov (Scott, a.k.a. Skeletor) apparently even disallowed "facilitators" for ACA, whose only mission was to educate.

The aca.gov site was always planned to augment the state exchanges....not to be the MAIN sign up spot. Every state has their own insurance regulations, ans if the states set up their own exchanges, they could weave their own "quirks" into the fabric of the ACA.. By NOT participating, they forced the .gov site to create not only the main site, but to add every one of the TWENTY SIX recalcitrant, obstinate states' vagaries to an already difficult mix.

Without expanding medicaid AND not creating a state exchange, their citizens could not even know if they qualified for anything they could afford, AND they were subjected to an onslaught of lies & propaganda.