The accuracy of the CBO prediction in 2009 must be understood only after considering the differences between the program which the CBO reviewed and the actual program after changes by the Supreme Court and the total lack of support by Republican states. The Supreme Court eliminated the people from Texas, Louisianna, Florida, and a large number of other Republican states which chose not to accept the Medicaid expansion. These states contained huge numbers of people who would have had insurance under the original bill, perhaps 5-10 million people. The state regulators in these same Republican states were the ones who made the rules for companies entering the insurance pool. The states made no effort to enroll customers and the parties in these states actively worked against the notion that people should sign up for the program. These parties are largely responsible for the diminishment of competition within the program and the loss of companies in the program.