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A 2010 report prepared for Kaiser Commission on Medicaid and the Uninsured by Washington D.C.’s Urban Institute shows the commonwealth could have the largest decrease rate of uninsured people in the nation under the Affordable Care Act.

The ACA allows states to choose whether to opt out of the Medicaid provision, which would fund 95 percent of a state's Medicaid budget on average, according to the report.  If Kentucky decides to expand Medicaid under ACA it could mean an extension of services for an estimated 250,000 uninsured people.

On average states would reduce the number of uninsured adults by 45 percent under ADA. In Kentucky, that number is 57 percent.

But it’s going to cost any state a lot of money to buy in.

Kentucky would need to come up with $515 million to receive the $11.9 billion available under the law.

The argument now becomes whether states have the money to invest and are willing to make the contribution, said report author John Holahan.

“The political forces will argue one way and I think the providers and business interests could argue the other side and it’ll be an interesting political dynamic to see how it plays out,” he said.

Holahan said it’ll be difficult for states like Kentucky to forgo the Medicaid expansion.

Gov. Steve Beshear said he plans to review the law before making any decisions.