It is no surprise to JHPPL readers that there is an incredible variation in political and policy responses to the ACA among the fifty states. In March 2015, the United States completed the second round of open enrollment for the health insurance marketplaces, and citizens faced drastically different choices depending on whether their state expanded Medicaid, whether their state set up their own marketplace and actively promoted enrollment, and how states defined the various benefit packages across these insurance mechanisms. In particular, when looking at state adoption of the Medicaid expansion, concerns arise for those 4 million insured Americans who remain uninsured due to state choices. This raises important questions about why and how states make these policy choices and how subject they are to change. For example, what is the likelihood of nonexpansion states eventually expanding? This is the question that...

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