All states

15% or more
total uninsured

30% or more
non-elderly eligible
for Medicaid expansion

30% or less
small businesses with
employee insurance

Challenged the Affordable Care Act


Did not challenge

Twenty-six states contested the constitutionality of two parts of the legislation:

Individual mandate, requiring most citizens to have a health insurance or pay a fine
Medicaid expansion, requiring states to expand coverage to include those within 138 percent of the federal poverty line or lose all federal Medicaid funding

The Supreme Court ruled the individual mandate constitutional but said states could choose not to expand Medicaid without losing existing funding.

Chose a federal insurance exchange




An exchange is the marketplace where insurance plans are bought and sold. States had to decide by Jan. 1 whether to have a state-operated exchange, set up a state-federal partnership or default to a federally maintained exchange.

State exchanges enable full control over operations. A partnership enables states to control some aspects of the exchange, such as managing insurance plans and assisting customers. Federal exchanges are established for states not able or willing to create their own. Only one state, Louisiana, had its application for a state-operated exchange denied.

Declined Medicaid expansion

Did not expand

Debate ongoing


The federal government provides funding for about 60 percent of the states’ Medicaid expenses. States have the ability to set Medicaid eligibility levels in relation to the federally set povery level. Coverage varies nationwide, from as little as 10 percent to as much as 215 percent for individuals with dependent children, depending on the state in which they reside. One hundred percent of the 2013 federal poverty level for a family of four is $23,550.

Under the Medicaid expansion, people with incomes up to 138 percent of the federal poverty line are eligible for coverage. The federal government will pay 100 percent of the costs for the first few years to cover this population and 90 percent thereafter.

SOURCE: Tables maintained by the Kaiser Family Foundation on state positions on the Affordable Care Act, state decisions on health exchanges and Medicaid expansion, uninsured estimates, implications of state Medicaid decisions, and firms offering coverage by size.