The Affordable Care Act that President Obama signed into law in 2009 was approved by the Supreme Court in 2012 with the caveat that states could opt out of the part that was run through an expansion of Medicaid. Many states chose to deny the expansion of Medicaid to their residents even though the federal government would pay all the costs for the first few years and most of the costs thereafter. The states that opted out of the free extension of Medicaid were clustered in the South, reflecting again the racecraft involved in such decisions on compensation of care.
