There is what the data research and experience says works. Then there is what is popular and what people feel works.
There have been many attempts to make it work this way. But many politicians, mostly of one party) believe that Medicaid is a bad thing and encourages bad behavior or subsidies bad choices. Also many have opinions of how economics work because there belief system has said so, and will contort all reality to fit their paradigm. So a compromise had to be reached with and that compromise is what we see today.
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