Because of this coverage gap, the turn-down of millions that would otherwise be injected into the economies of the red states that rejected medicaid expansion, and the reality that those red states' taxpayers are paying for expansion in the blue states, it would seemingly be very difficult for the non-expansion states to hold out much longer. According to the WSJ article, the problem created by "Red" States opting out of medicaid is essentially this: The ACA was to cover low wage workers via medicaid expansion. However in the States that rejected expansion, depending on individual State eligibility requirements, many low wage workers can't qualify for medicaid because they make too much, but at the same time they make too little to fall into the subsidized ACA categories. The ACA was drafted assuming those low wage workers would be covered under expanded medicaid. In practice, the gap created by Red States opting out has meant that someone making $200/week, say, is shut out of access to medical care other than through emergency rooms, whereas someone making just $108 more per month would qualify for 100% federal healthcare insurance subsidy. See Millions Trapped in Health-Law Coverage Gap The Wall Street Journal By Christopher Weaver 6 minutes ago BIRMINGHAM, Ala. Please see the WSJ or the folowing link for the complete story http://finance.yahoo.com/news/millions-trapped-health-law-coverage-034100534.html