Health reform was enacted into law in Washington, D.C., but many of the decisions around implementation will be made at the state level. In the coming months and years, states will wrestle with the economic, legal and clinical aspects of reform. Their ability to successfully navigate these issues will have a direct impact on tens of millions of Americans. In a report funded by the Robert Wood Johnson Foundation, Urban Institute authors John Holahan and Stan Dorn look at the many ways health reform will affect states.
According to the authors, the main components of the Patient Protection and Affordable Care Act that will affect state governments will not be implemented until 2014, when Medicaid coverage will substantially expand in most states. Federal funds will pay most of the resulting new costs, but there will be modest increases in state Medicaid spending on adults with incomes up to 133 percent of the federal poverty level.