How do you exempt entire states from obamacare?

  If you put into a place a law that is supposedly good for the people (health care is a right), why would you exempt entire states from having to enforce it? By doing so, aren't you signaling that your law isn't really a law but rather a command? 
  The fact that four states including Ohio are exempt from obamacare does not make sense according to the illogic used by the people who wrote it. There have been utterances such as "equal protection under the law" and "everybody has a constitutional right to health care" and mutterings about the 14th amendment and the 5th amendment.
  The defenders of obamacare have claimed that it isn't fair that only working privileged people have health care which isn't true considering that so much of our budget is based on medicare and medicaid.
  Recently there was a situation locally where a woman's mother in law, whose husband was a black WW2 veteran, needed to enter a nursing home. Her husband was dead and she had no one to care for her so she had to sell everything and put it into living in a skilled nursing center. Once there, she met other folks, some of whom did not speak English and had never worked, whose entire tab was being picked up by the federal government. This woman's mother in law was upset by the fact that, as the widow of a WW2 veteran, she had to give up everything but someone who was an immigrant who had never contributed to the system was getting a free ride. 
  Assuming obamacare was instituted to rectify a situation like this, how does it make sense to exempt the entire state?
  As residents of Ohio, we think this development is great, as will the local doctors who have dreaded the onset of the dis-ease called obamacare, but it would seem that there is no sense, logical or legal, in exempting entire states from having to enact this terrible law.
  Obviously not everyone who applied for waivers received them, since 50 were turned down.
  What criteria were used to turn those entities down?
  And, once again, if this law is so great, why are some people getting exemptions and others not? 
  What was the rationale for deciding? 
  If the criterion is hardship, why wouldn't states like California, Michigan and Illinois be exempted? 
  And who in Ohio applied for the waiver? Strickland? What criteria were given to establish the waiver?
  None of this makes any sense. It certainly seems that HHS has some explaining to do and, indeed, has nullified the need for such an outrageous law.
  And don't we all deserve equal protection under the law?
  But is this a clue to what is happening from the Huffpo, written back last year?

It's called the "Empowering States to be Innovative" amendment. And it would, quite literally, give states the right to set up their own health care system -- with or without an individual mandate or, for that matter, with or without a public option -- provided that, as Wyden puts it, "they can meet the coverage requirements of the bill."

  If this is the case and Ohio is now obligated to set up its own health care system, what if (ha!) the state is broke and cannot afford to do so? And now that the state has gone red again, who's going to set it up? 
  And most especially, where's the money going to come from to do this?
  Wyden says people are silly for suing to not enact this law because all they have to do is create their own health care systems; this fantasy attitude is typical of liberals. Hey, free college! free house payments! free insulation and new windows for your house! free health care! free EVERYTHING!
  But who's going to PAY for it?
  Do they not understand: There's no more money!