By Martha Heberlein

As legislative sessions are kicking off, it will be interesting to see which states take steps towards implementing the Affordable Care Act (ACA) this year. A new report from the Urban Institute and the Robert Wood Johnson Foundation shows that those states that have been moving most slowly on reform are also the one’s whose residents have the most to gain from it.

The study divides the states into three groups:

1. Group 1 includes the 15 states that have either established an exchange through legislation or an executive order. {They are: CA, CO, CT, DC, HI, IN, MD, MA, NV, OR, RI, UT, VT, WA, and WV.}

2. Group 2 is made up of the 21 states that, while not having established an exchange, have demonstrated interest in doing so, such as by receiving an establishment grant. {They are: AL, AZ, DE, ID, IL, IA, KY, ME, MI, MN, MS, MO, NE, NJ, NM, NY, NC, PA, TN, VA, and WI.}

3. Group 3 represents those 15 states that don’t fit into either of the above groups (although 9 of these states have made progress by setting up a study or planning group). {They are: AK, AR, FL, GA, KS, LA, MT, NH, ND, OH, OK, SC, SD, TX, and WY.}

Let’s start with the uninsured – Group 1 and Group 2 are expected to see similar declines in the number of uninsured people following implementation of the ACA. Group 3 states start with a higher baseline of uninsured, but are expected to see a greater decrease (in almost all cases, exceeding 50%) in the number of uninsured than states in Groups 1 or 2.

Group 3 is also expected to see the largest gain in the number of people covered by Medicaid or CHIP (an overall increase of 54%), while Groups 1 and 2 see an increase of about 30%. Enrollment among those who are currently eligible is expected to increase by 1 to 2 percentage points across all states, regardless of which group they fall into. (As always, there is variation among the states within each group).

The gains in coverage through the exchanges are comparable across groups; however, Group 3 will have the largest share of their population receiving subsidies and a higher per capita subsidy relative to the other two groups of states.

With their residents having the most to gain in terms of affordable coverage for themselves and their families – it will be interesting to see whether the states in Group 3 pick up the pace or whether residents will have to wait for the federal government to step in instead?