Updated June 28, 2015.

Have you heard that you can’t get Obamacare health insurance if you live in a Republican-led state? Don’t believe it.

In every state, whether the dominant political party is Republican or Democrat, you can enroll in a health insurance plan that complies with the Affordable Care Act. Obamacare plans, generally considered to be plans that are sold by private insurance companies on state or federal health insurance exchanges, are available to you if you reside legally in the United States no matter which state you live in.

What’s the Confusion?

The misinformation is probably due to confusion about the difference between Medicaid and Obamacare, or confusion about some states using the federal government’s health insurance exchange rather than creating their own.

State Vs Federal Health Insurance Exchange

First, let’s tackle the confusion about health insurance exchanges.  Health insurance exchanges are where health insurance companies sell their Obamacare health plans. Most people who buy their health insurance on Affordable Care Act health insurance exchanges do it through the exchange’s website.

States have the option of creating and running their own health insurance exchange, or using the federal health insurance exchange, HealthCare.gov. If your state didn’t create its own health insurance exchange, you can still buy an Obamacare health insurance plan. You buy it through the federal exchange, HealthCare.gov.

If you live in a state that didn’t create a state health insurance exchange, the health insurance you buy through the federal exchange will still be a health plan for your geographic area and regulated by your state’s Department of Insurance or an equivalent state agency.

Medicaid Vs Obamacare

Medicaid and Obamacare aren’t the same thing. Medicaid was around for decades before the Affordable Care Act and the advent of Obamacare.

Medicaid—What Is It?

What Exactly Is Obamacare, Anyway?

Medicaid is a social welfare program much like SNAP (food stamps) and TANF (Temporary Assistance to Needy Families.) It provides health insurance to low-income people.

Following federal guidelines, each state administers its own Medicaid program overseen by the Centers for Medicare and Medicaid Services, a federal government agency. The health insurance Medicaid provides is funded in part by the federal government and in part by each state.

Since Medicaid programs are administered at a state level, how Medicaid works and the benefits it provides can vary from state to state as long as it complies with basic federal guidelines. Thus, California’s Medicaid program is different than the Medicaid program in Texas, for example.

The Affordable Care Act Impacted MedicaidLeading to Confusion

The Affordable Care Act tried to change the rules about who was eligible for Medicaid making it easier for people to qualify. The ACA’s authors wanted everyone with incomes below 138% of federal poverty level to be able to get Medicaid no matter what state they lived in.

However, the Supreme Court ruled that the federal government couldn’t force a state to expand its Medicaid coverage. The ruling made expanding Medicaid optional. The result is that some states offer Medicaid to everyone with incomes below 138% of federal poverty level, and some states stick to the older, more complicated rules only covering people in certain eligible groups, like pregnant women and the disabled, meeting income guidelines.

Not surprisingly, states that chose not to expand Medicaid eligibility tended to be more conservative politically and led by Republicans. States that chose to offer Medicaid to all residents with incomes below 138% of poverty level tended to be more liberal politically and led by Democrats.

Hence, it’s true that in some Republican-led states you may not be able to get Medicaid even if you have a low income. Those states may follow the older eligibility rules and limit Medicaid eligibility to people who are both low income and from a particularly vulnerable group such as pregnant women, the disabled, and the elderly.

However, it is not true that Republican-led states don’t have Obamacare plans. You can still buy private health insurance on an Affordable Care Act health insurance exchange even in states that didn’t expand their Medicaid rolls. Residents of states that didn’t create their own state-run health insurance exchanges simply use the federally run health insurance exchange, HealthCare.gov.

Find out if your state participates in the ACAs Medicaid expansion, or sticks with the old rules.