For many people without insurance, a key question raised by the Supreme Court's decision today to uphold the Affordable Care Act is whether states will decline to participate in the law's big Medicaid expansion. Although the court upheld the law's mandate requiring individuals to buy insurance, the justices said the act could not force states to expand Medicaid to millions by threatening to withhold federal funding. Republican leaders of some states already are saying they are inclined to say thanks, but no thanks.