So far, implementation of the PPACA has varied across states, according to a Commonwealth Fund report. The District of Columbia and 26 states have chosen to expand their Medicaid programs to people earning as much as 138 percent of the federal poverty level this year, while Indiana and Pennsylvania are looking into expansion after 2014. Nearly all of the states will require or encourage compliance with health insurance market reforms, and every state will have an exchange (although some have chosen to let the federal government run their marketplaces).
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