With state legislatures working their way through their 2014 sessions, attention in a number of states is focused on the actions states can take to further implementation of the Affordable Care Act (ACA). Although the name “Obamacare” focuses attention on the President, his administration, and the federal bureaucracy, state actions will also be determinants of the success of the ACA. In particular, poor adults in more than half the states, including parents and parents-to-be, will remain uninsured — as will many children who would have enrolled in Medicaid when their parents did — unless, and until, those states implement the Medicaid expansion. In addition, the failure, to date, of the majority of states to develop their own marketplaces has shifted more of the burden onto the federal marketplace. Even in states with a federally facilitated marketplace, states have important roles to play in regulating insurance companies and enrolling people found eligible for Medicaid and the Children’s Health Insurance Program (CHIP) in those state-run programs.

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