The Medicaid enrollment numbers are a bigger reflection of how little people are being compensated: in states that adopted Medicaid expansion under the ACA, only those making a certain percentage of the federal poverty level are eligible for the program.

In states that adopted Medicaid expansion, that usually means 100% to roughly 138% of the FPL. The FPL for a single individual in the 48 contiguous states + DC is $12,140.

Workers whose income is above the FPL cannot default to Medicaid, even if they cannot afford to buy insurance.