WASHINGTON -- Here's a reality check for President Barack Obama's healthcare overhaul: 3 in 4 uninsured Americans live in states that have yet to figure out how to deliver on its promise of affordable medical care.
This is the year that will make or break the healthcare law. States were supposed to be partners in carrying out the biggest safety net expansion since Medicare and Medicaid, and the White House insists that they're making steady progress.
But an analysis by The Associated Press shows that states are moving in fits and starts.
Combined with new insurance coverage estimates from the nonpartisan Urban Institute, it reveals a patchwork nation.
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Such uneven progress could have real consequences.
If it continues, it will mean disparities and delays from state to state in carrying out an immense expansion of health insurance scheduled in the law for 2014. That could happen even if the Supreme Court upholds the law, called the Patient Protection and Affordable Care Act.
"There will be something there, but if it doesn't mesh with the state's culture and if the state is not really supporting it, that certainly won't help it succeed," said Urban Institute senior researcher Matthew Buettgens.
The 13 states that have adopted a plan are home to only 1 in 4 of the uninsured. An additional 17 states are making headway, but it's not clear all will succeed. The 20 states lagging behind account for the biggest share of the uninsured, 42 percent.
Among the lagging states are four with arguably the most to gain. Texas, Florida, Georgia and Ohio together would add more than 7 million people to the insurance rolls, according to Urban Institute estimates, reducing the annual burden of charity care by $10.7 billion.
"It's not that we want something for free, but we want something we can afford," said Vicki McCuistion of Driftwood, in Central Texas, who works two part-time jobs and is uninsured. With the nation's highest uninsured rate, her state has made little progress.
The Obama administration says McCuistion and others in the same predicament have nothing to fear.
"The fact of states moving at different rates does not create disparities for a particular state's uninsured population," said Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the federal Health and Human Services Department.
That's because the law says that if a state isn't ready, the federal government will step in. Larsen says the government will be ready.
Some states, mainly those led by Democrats, are far along. Others, usually led by Republicans, have done little. Separately, about half the states, including Texas, are suing to overturn the law.
Gov. Rick Perry's opposition to the law scuttled plans to advance a healthcare bill in the Texas Legislature last year, when Perry was contemplating his presidential run.
The Legislature doesn't meet this year, so the situation is unclear.
In states where Republican repudiation of the healthcare law runs deep, there's little incentive to advance before the Supreme Court rules. A decision is expected this summer, and many state legislatures aren't scheduled to meet past late spring.