>The Supreme Court said the ACA could not force the states to take the (federally funded) Medicaid expansion

The medicaid expansion is only fully federally funded for the first 3 years. It goes down to 90% by 2020 (Edit: I originally wrote 2014), and could very easily be pushed below that later on--Republican governors used that as an excuse not to expand.

I think they could have passed a bill that either allowed people making below the poverty level to use the exchanges with subsidies or they could have fully funded the medicaid expansion. I really don't think adding a small fractional increase in total cost would have killed the bill.