Crash is right in some respects. When you look at the rate differences, the states which opted for the Medicaid monies typically have lower premiums. the reason is because more people went into the Medicaid coffers instead of the typical exchange where they caused a bigger skew of costs to the insurance companies. However, those states are now on the hook for the money for these policies, and they much raise their tax rates or fall behind in supplementing the Medicaid budget. If Trump wants to succeed at ridding us of this Obamination he could do a few things differently.
Take the government dollars out of the hands of the insurance companies. It should have never been there to begin with. Make them continue to cover people until they are 26 years old on their parent's plans, but do away with the pre-existing clause. Those with pre-existing conditions that cannot get a policy can petition for government coverage under Medicare, and when proper vetted financially, go into the medicare coverage plan. The money that was going to the insurance companies goes into Medicare coverage. Purchase or appoint an insurance company to provide a catastrophic insurance plan that will cover up $100,000 in benefits to those will critical illness, so that they cannot be financially non-viable. If people then continue to not carry optional coverage, make the penalty work by allowing hospitals or providers to seek financial payment more easily.
Decrease the costs of medical school by making more government loans available to students, but hold those people to two years of health service in government run health centers or hospitals. Private loans will still be available to those who do not want to go this route.