If you do not qualify for Medicaid or if your state has not expanded their Medicaid Program and you earn less than $11K/yr($25K family of four) you ARE left out except for the fine of not having med. ins. ($95 or 1% of income---whichever is HIGHER first year and then it increases each year.)
Below the poverty level one can purchase med. ins. via the exchange but if you are below poverty level you don't have $100(+) a month to cover premiums AND deductibles--out of pocket costs.
ACA was touted as medical coverage for all------except for those 4 million plus folks that really could use it.
When congress has to have the same programs (med. ins., pensions, retirements) then something good for America and Americans may actually happen.