As the press and pundits rush to judgment (apparently) on deciding how "Obamacare" is going they ought to actually stop to ponder that the Affordable Care Act is not just one program, not a federal program, rolling out the same in every part of the country.  In fact, what we are witnessing is essentially 51 different health reforms being rolled out in the 50 states and D.C., and taking on different forms everywhere.

One way to characterize the way this is rolling out is on two major dimensions: (1) has the state adopted a state-based Marketplace or a "federally-facilitated" Marketplace, and (2) has the state decided to expand Medicaid.  

It turns out that we know about half the country has adopted state-based Marketplaces, and about half the country has decided to expand Medicaid, more or less.  See the Table characterizing state decisions.

And as I noted in a previous post (below), the Marketplaces are being implemented much more smoothly in the states that adopted state-based marketplaces, with almost 300,000 already enrolled.  And of course we also know that about 5 million people will be essentially not able to access affordable coverage in the states that do not expand Medicaid.

So to put it another way, we are looking at "Have-Not" states and "Have" States in terms of whether they will provide their citizens with access to coverage or not.  And, as you would probably expect, almost all (24 out of 25) of the states that decided NOT to expand Medicaid also refused to implement State-based Marketplaces, so they have a federal Marketplace (the now infamous healthcare.gov).

In contrast, the majority of states that implemented Medicaid expansion also have a state-based Marketplace (16 of the 26 states), while the rest have a federal Marketplace (and most of those actually have a "Partnership" Marketplace with the federal government).  

As the Table also shows, these decision largely break down upon party affiliation, as defined by the way the state voted in the last Presidential election.  For example, of the 16 states that chose to expand Medicaid and adopt a state-based Marketplace, 15 of these 16 states are "blue" states that voted for President Obama in 2012.  In contrast, 18 of the 24 states that have chosen so far not to expand Medicaid and also have chosen to go with the federal marketplace are "red" states that supported Romney in the 2012 election.