Second, we tested for differential effects in the subgroups most likely to gain insurance under the ACA. As noted above, the ACA affects all states; however, coverage gains should vary according to income and state decisions regarding Medicaid expansion. Newly available subsidized coverage under the ACA is targeted to low-income adults (≤138% of the federal poverty level) in states expanding Medicaid and middle-income adults (139 to 400% of the poverty level) in all states. Adults with income that is greater than 400% of the poverty level may experience changes due to the mandate, cancellations of previous plans,7 and other regulations, but these effects are likely to be smaller than for other groups.