On Monday, ABC News online reported that Tennessee state Senator Brian Kelsey handed a humorously titled book to Kathleen Sebelius, the U.S. secretary of health and human services.

The book, titled “Websites for Dummies,” was a obviously meant as a jab at the recent system failures on the exchange websites set up to initiate the Affordable Care Act.­

Kelsey told news reporters that his little gift was meant to remind Sebelius that, “Tennessee does not want Medicaid expansion.”

Kelsey’s snarky sentiments in giving the book are somewhat humorous. Unfortunately, politics are not an episode of “It’s Always Sunny in Philadelphia,” so snark and sarcasm are not really all that effective.

Kelsey was correct in calling the Affordable Care Act “Medicaid expansion” and he was not making a misnomer comparison. Its very makers have described the Affordable Care Act as “Medicaid expansion.”

With Medicaid, the federal government gives each state waivers to create Medicaid managed programs. Within these programs, citizens of a state are enrolled in a private health plan that receives monthly premiums from the state’s managing office. Each state determines the eligibility standards, the types of care covered and the rate of payment.

Under the Affordable Care Act (aka Obamacare), this will be expanded to include new categories. Basically these categories are just expansions on age and the definition of low-income.

Interestingly, some state legislatures have opted out of expanding Medicare. What does this mean in conjunction to the Affordable Care Act? It means the citizens of that state are eligible for Obamacare but are not eligible for Medicaid.

This is where Obamacare becomes a conundrum to many Americans. The health care plan is neither socialized medicine nor is it a completely free-market platform.

People who do not have health insurance through their employer can now buy health insurance without it costing the proverbial arm and leg, supposedly.

After all, cost is relative to income. For those people in Medicaid expansion states they can receive relatively cost-less insurance because their premiums will be subsidized. For those, who do not live in expansion states, they may not have employer insurance, nor can they afford the premiums that are still required to be paid by the insured under Obamacare.

There are myriad issues with Oabamacare, but a glaring and easily explainable one is the fact that there is still a divide between the privately insured, those insured by Medicaid and those who can afford neither.

Unfortunately, many people were under the impression that this would be some kind of socialized medicine program.

I’ve heard people who despised being on Medicare talk as though the fruition of Obamacare would allow them to have the same treatment given to those with the most all-inclusive health insurance.

Granted, Obamacare does allow some people to acquire some very inclusive insurance. Generally, these people previously did not qualify for health insurance but could afford it. They simply had a preexisting condition.­ Another, possibly acceptable facet of the program is it’s allowing unmarried children up to the age of 26 to stay on their parents’ health insurance.

So in some cases, the pillars of Obamacare allow for some much-needed benefits. However, the confusion caused by the program and the confusing state of the online exchanges show us that, per usual, the fumbling decision making caused by government largess has wasted money, caused an upset in the health care service and still has some people left out in the cold.