In his May 19 letter “There were glaring deficiencies with the Affordable Care Act,’’ Marvin Wool claims that states were able to opt out of the Medicaid expansion because of a provision that Nancy Pelosi, then House speaker, put in the bill to woo blue dog Democrats. The bill as passed actually required states to expand Medicaid. This provision was struck down by the Supreme Court in the Republican-initiated case National Federation of Independent Business v. Sebelius.

Wool also claims that the ACA did not incentivize enough healthy enrollees to join the insurance pool. There was an attempt to accomplish this by fining people who did not join. Perhaps the fine was not large enough to succeed. But problems getting enough people to sign up were exacerbated by the fact that enforcement of this provision was delayed, and now President Trump has instructed the IRS not to enforce it at all.

Michael Biales

Acton