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The Affordable Care Act, largely intended to help the nation's poor and uninsured, was altered by a U.S. Supreme Court ruling allowing the states to opt out of an enhanced 1__________ program. As a result of the Court's decision, more than twenty states, predominately located in the 2_________ , chose to opt out, citing costs. As a result of these opt-outs, coverage will be eliminated for an estimated 3________ Americans, highlighting the differences that remain between the states on this issue.

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