When the Supreme Court ruled that under the Patient Protection and Affordable Care Act, states could not be compelled to expand Medicaid,1 it opened an unusual divide for public insurance coverage in the United States. Starting January 1, 2014, adults 19 to 64 years with family income up to 138% of the federal poverty line (133% plus a 5% income disregard) became eligible for Medicaid in 25 states and the District of Columbia (expansion states). In the remaining 25 states (nonexpansion states), while adults with incomes between 100% and 138% of the federal poverty line qualify for subsidized insurance coverage through the new marketplaces, those with income below the poverty line will not qualify and therefore are likely to remain uninsured. Previous estimates indicate that more uninsured adults who could have been made Medicaid eligible live in nonexpansion states (8.5 million) than in expansion states (6.6 million).2
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