The Kaiser Family Foundation is one of the premiere resources for nonpartisan information regarding health policy issues. It recently released reports for each state and DC that include information about different demographic groups' eligibility for new health insurance coverage options under the Affordable Care Act. 

While it has long been known that the impact of the ACA in terms of extending insurance coverage would vary by state, recent developments since the open enrollment period began October 1, 2013 will have the effect of creating even more of a patchwork around the country. For example, many people who were expected to have acquired coverage in the small group or individual health insurance markets that was supposed to be subject to the essential health benefit requirements may have instead been able to maintain their existing policies. And those existing policies may not cover occupational therapy services as comprehensively as plans sold on the health insurance marketplaces. 

A separate issue of importance in terms of creating discrepancies between the states is that Medicaid eligibility has only been expanded in approximately half of the states. As a result of the Supreme Court's decision in June 2012 that Medicaid expansion is optional, many individuals in states that are not expanding Medicaid eligibility will find themselves in a coverage gap. When drafting the ACA, its proponents in Congress anticipated that people with incomes below 100% of the federal poverty level would have access to health insurance through the national expansion of Medicaid eligibility. As a result, the law actually prohibits health insurance premium subsidies from being provided to that income group. Therefore, a paradox has been created where people with higher incomes in states that are not expanding Medicaid eligibility can access subsidies to assist in the purchase of private health plans, while lower income people have no affordable options.  

It's important to realize that while the ACA is often and understandably described as having a national impact (after all, it is a federal law), the real impact of its implementation will depend significantly on the specific state OT practitioners and consumers live in.