 [ Symptoms ] what are those who live in states that did not participate in the health exchange supposed to do for health care access  especially when they can not afford insurance even with a subsidy andor are unemployed why was not medicaid opened nationally where those like me that still can not afford healthcare at a discounted price would still be able to get medicaid regardless of what some of our governors did not do but should have [ Disease ] the perverse situation in states that do not expand medicaid is that it is people with lowest incomes who can not afford insurance without financial help who will be left without options medicaid is a joint statefederal program and the law was written in a way that required states to expand their program then the supreme court reversed that piece of the law making it optional for states and a number of governorsstate legislatures chose not to expand