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Analyzing the Impact of State Medicaid Expansion Decisions

One of the major vehicles in the Affordable Care Act (ACA) to increase health insurance coverage is an expansion of Medicaid to adults with incomes at or below 138% of the federal poverty level (FPL). While the expansion was intended to be implemented in all states, as a result of the Supreme Court decision on the ACA, it is now effectively a state choice. States are divided about implementing the Medicaid expansion.  As of July 2013, 24 states are moving forward with the expansion, 21 states are not planning to move forward, and there is ongoing debate in 6 states. This brief highlights 5 key ways that state decisions will shape the outcome of the Medicaid expansion.  Without the Medicaid expansion there will be large gaps in coverage; significant implications for health care for the uninsured; consequences for certain regions and for people of color; coverage and fiscal implications for states, and implications for uncompensated care and hospitals.