The state typology developed here highlights states’ different circumstances both before the ACA and four years after implementation. States that already had high coverage levels before the ACA and expanded Medicaid made additional progress, but their percentage-point advances tended to be smaller than other states’ because they began the reform process in a better position. Many remaining states that did not expand Medicaid and did not have robust subsidized marketplace enrollment experienced much smaller reductions in their uninsurance rates.
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The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.