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All But 5 States Taking Action to Implement ACA Insurance Reforms

Although their approaches may vary, most states have taken steps to prepare for the Affordable Care Act’s health insurance market reforms, marketplaces, and Medicaid expansion, a new Commonwealth Fund report finds.

The 10 states that have done the most to implement the health reform law’s major components—California, Colorado, Connecticut, Hawaii, Maryland, Massachusetts, Minnesota, New York, Oregon, and Vermont—have set up their own insurance marketplaces, expanded eligibility for Medicaid coverage, and enacted all, or nearly all, of the insurance market reforms to ensure that consumers benefit from the law. At the other end of the spectrum are the five states—Alabama, Missouri, Oklahoma, Texas, and Wyoming—that have declined to play any role in implementing the law’s reforms.

The study was prepared by Katie Keith and Kevin Lucia of the Georgetown University Health Policy Institute’s Center on Health Insurance Reforms.

Visit to learn more about the study, use our interactive state map and view our infographic.

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