The Affordable Care Act created financial incentives to expand Medicaid programs. Some states expanded Medicaid and others didnt. Those that didnt claimed that they would be left with long term costs after the federal funding expires. The states that expanded their Medicaid programs are more dependent upon federal the government as the result the expansion. Do you think that the states that expanded will be able to sustain the future costs of this health policy? Do you think federal dependency will benefit the states that were incentivized to follow the federal policy? Does a rejection by a state permit the state to have more power in relation to promoting the states interests?