Against a groundswell of state-based unrest, the Patient Protection and Affordable Care Act continues to churn forward under a blanket of contention.

As more than half of the 50 states inch forward with legal action to stop implementation of the health care reform plan, a new report released Tuesday states that nearly 28 million non-elderly U.S. residents would receive health care insurance coverage if the plan were fully implemented this year.

According to the Urban Institute, which conducted the research for the Robert Wood Johnson Foundation, a Washington-based research organization, a full implementation of the law would reduce the number of uninsured younger than 65 to 23.2 million (currently at 50.9 million). In turn, says the report, the rate of uninsured would decline to 8.7% from 18.9%, lowering the nation’s uninsured rate by more than 10 percentage points.

The report was released on the heels of President Obama’s comments on Monday during a meeting with state governors where he acknowledged the challenges individual states are having in implementing the law and offered support for a proposal that extends flexibility to the law.

The law tasks the states with carrying out many of the reforms, including establishing exchanges where individuals can buy health insurance. Although much work has taken place on establishing the exchanges, providers are struggling with being able to meet the deadlines that are inherent in the law.

On Monday, the president noted a portion of the law that would grant states a waiver to tailor their own solutions to health care reform in 2017 if they fulfilled the same goals as his reforms do. Obama also signaled support for a proposal co-sponsored by Sens. Ron Wyden (D - Ore.) and Scott Brown (R - Mass.) and Mr. Wyden that would set the date for the state-based waiver at 2014 instead of the 2017.

"If your state can create a plan that covers as many people as affordably and comprehensively as the Affordable Care Act does — without increasing the deficit — you can implement that plan," Obama told the governors. "And we'll work with you to do it," he said.

The White House announcement was the latest push by the federal government to show sympathy for states' concerns. Last week, the Health and Human Services Department announced a variety of grant programs to help fund state programs to review health insurance rates, pay for the administration of insurance regulation, and provide home health care to Medicaid enrollees.

Provisions of the law that go into effect in 2014 that will have the greatest impact in reducing the number of uninsured make more people eligible for Medicaid and provides federal premium subsidies for the lower-income uninsured. States recoiled at the projected costs associated with the larger Medicaid rolls, so Congress agreed to pay 100% of the costs for new enrollees.

Many states worried they cannot absorb even restricted costs due to the financial crisis believe this is not adequate, especially in light of the ever-increasing number of laid-off workers turning to Medicaid for assistance. Currently, Medicaid on average takes up a third of states’ budgets. During his meeting on Monday, Obama asked the governors to create a bipartisan committee tasked with finding ways to bring those costs down.

After the White House meeting, Senator Orrin Hatch, (R-Utah) and ranking member of the Senate Finance Committee, said the president's announcement amounted to a public relations stunt.

"States don't need more press releases and talking points, they need action from Washington to reduce the burdens of this disastrous law," he said.

Notably, although the law would mean that the nonelderly uninsured rate would decline in all 50 U.S. states, it would vary widely, according to the Urban Institute’s analysis. In Texas, where the Urban Institute estimates the uninsured rate at 29.7%, would see a drop to 12.8%. In New Mexico, the rate would fall from 28% to 12%. In Massachusetts, where a 2006 state law has established near-universal coverage, the law would have minimum impact on the uninsured.

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Corrected March 2, 2011 at 10:49AM: yes