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The Affordable Care Act will expand Medicaid eligibility starting in 2014, but a Supreme Court ruling that there will be no penalty for those states refusing to comply, or who later withdraw from the program, has left many state legislators questioning how to proceed.

Ratcheting up the campaign to sell the health law, President Barack Obama delivered a speech Thursday touting how millions of individuals are already benefiting from its insurance rebates, and others who buy coverage online in states such as California, New York and Oregon will pay lower-than-projected premiums next year because of increased competition.