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Is Obamacare available in all states?

Some parts of it are — but not all of it.

A map of the states that have and haven’t done the Medicaid expansion. Kaiser Family Foundation

Some parts of it are — but not all of it. Every state does have an insurance exchange. Every state also has financial subsidies to help middle-income Americans to help buy private coverage.

Only 28 states are participating in the Medicaid expansion — the part of the law that was meant to cover 17 million people who earn less than 138 percent of the federal poverty line (about $15,000 for an individual or $31,000 for a family of four).

medicaid expansion map Advisory Board

When it was written, Obamacare initially required all states to expand their Medicaid programs. Before Obamacare, there was lots of variation in whom states did and didn’t cover; the idea was to create a more standard and much bigger Medicaid program.

The Supreme Court changed that. Its June 2012 ruling found this requirement to be too onerous on states — which help pay for Medicaid — and that each state would get to decide whether to expand the program.

Twenty-eight states and the District of Columbia have so-far opted into the Medicaid expansion. Seventeen are currently opting out and another five are on the fence, with legislators and governors weighing their options.

Poor people in non-expansion states are pretty much out of luck

People who earn less than the poverty line cannot qualify for subsidized private insurance, and typically do not have access to affordable coverage.

The legislators who wrote Obamacare anticipated that this population would gain Medicaid coverage and so did not include them in the subsidies. That’s left some of the poorest Americans in a coverage gap, where they are too poor to earn subsidies to help purchase insurance.

medicaid gap Kaiser Family Foundation

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