The Affordable Care Act (ACA) expands healthcare coverage and improves healthcare delivery. While the ACA expands Medicaid coverage, many states have yet to expand. This paper utilizes a multi-state comparison case study comparing New York, a Medicaid expansion state, and Florida, a non-expansion state, to better understand Medicaid expansion decisions and influences in states. The case study identifies that the reasons behind these decisions are layered and complex; influences such as state political parties, lobbying, and overall state economics greatly influence Medicaid expansion policy
