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The ACA's Medicaid Expansion: Alternative State Approaches

Twenty-six states and the District of Columbia are increasing eligibility for Medicaid under the Affordable Care Act. But in states not expanding Medicaid, nearly 5 million uninsured people are at risk of falling into a coverage gap. These states are also forgoing millions in federal dollars, even as their residents are helping to finance expansions in other states through the income taxes they pay.

Certain states, however, are pursuing alternative approaches to covering low-income people. A new blog post by The Commonwealth Fund's Tracy Garber and Sara Collins examines the different paths that Arkansas, Iowa, Michigan, and Pennsylvania are taking, and the options several other states are considering—including enrollment of the poorest residents in private health plans and greater cost-sharing. Also see our updated interactive map on state Medicaid expansion.

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