Prediction test: Probable double-post:
Is his state on or off the fed exchange?
Let's just say some of the more "red" states didn't have much interest in making it work. Many didn't even close the medicaid/ACA gap. Others didn't subsidize it much with their own state money. Etc. There was a lot of "let's make ACA fail" mentality from the get-go. And a lot of work in congress to mess with it, and a lot of compromise even to get the initial version signed.
We just need medicare for all probably supported a variety of ways, including but not exclusive to, a national sales tax. Or maybe even better...a CARBON tax on the PRODUCERS.

But I don't want to start too many fights because snails is "not over there".