The refusal of 24 states to expand Medicaid under Obamacare will maintain their high levels of inequality in healthcare coverage

The United States is the only industrialized democracy that does not have universal health care coverage, and nearly one in five Americans do not have health insurance. The Affordable Care Act (commonly known as ‘Obamacare’) aims to extend health insurance to under and uninsured Americans by having them enroll in state or national “exchanges,” or online marketplaces; and by providing federal funds to states to expand their Medicaid coverage. Since the Act is implemented predominantly by the states, the benefits of the Act for uninsured Americans depends heavily on what states do, or refuse to do with Medicaid coverage and the state exchanges. Ling Zhu and Morgen Johansen examine what the U.S. states can do to address inequality in health insurance coverage.