States were to expand Medicaid in conjunction with his expanding ACA explicitly to handle situations like you brought up.

This was not 14 years ago.

https://en.wikipedia.org/wiki/Medicaid_coverage_gap#

“Expansion of Medicaid was a key aspect of the ACA when it was signed into law by President Barack Obama in March 2010”

He would have to be quite a fool to make the same mistake again of leaving it up to the states to expand Medicaid