The Affordable Care Act's expansion of Medicaid eligibility hasn't been universal.

Medicaid is the federal-state health care program for Americans that historically focused on pregnant women, children, seniors and the disabled.

President Obama's namesake health care law expanded Medicaid eligibility to all adults under age 65 with incomes up to 133 percent of the federal poverty level. Under the law, states were essentially required to expand eligibility or risk losing federal funding to their existing programs.

But following a rather complicated 2012 Supreme Court decision, Medicaid expansion became optional. As of Dec. 1, 2016, 19 states so far have refused the expansion.

"I don't think anyone anticipated when the law was written that states would have the opportunity to opt-out of the Medicaid expansion," Christine Eibner, senior economist at the Rand Corporation, told us in 2015. "That's a major departure from the law's initial intent."

In states that are not participating, coverage is generally capped for those with children who have incomes at 44 percent of poverty (about $8,870 a year for a family of three) while childless adults remain ineligible in nearly all of them. According the Kaiser Family Foundation, that amounts to a coverage gap of 2.6 million people.

Obama tried to achieve this goal, but the Supreme Court curtailed complete implementation. We rate this a Compromise.

The health care bill signed into law by President Barack Obama kept his promise to "expand eligibility for the Medicaid and SCHIP programs and ensure that these programs continue to serve their critical safety net function."

Even before passage, we had already rated the SCHIP portion a Promise Kept. Now, with passage of the health care bill, Medicaid -- the federal-state program that provides health coverage for lower-income Americans -- will see a landmark expansion.

Historically, Medicaid coverage has been focused primarily on pregnant women, children and the disabled. Under the new law, eligibility will be expanded to all individuals under age 65 with incomes up to 133 percent of the federal poverty level. New beneficiaries will be assured a package that includes essential health benefits.

This new coverage is set to begin in 2014, but we believe the enactment of the law fulfills Obama's promise. If something happens to derail this policy change before 2014, we will adjust the rating, but for now, we're considering it a Promise Kept.

After months of talking about health care reform, the U.S. House of Representatives introduced major legislation to overhaul the nation's health care system. House Democrats unveiled the 1,000-plus-page bill, called America's Affordable Health Choices Act of 2009, on July 14, and it includes most of President Barack Obama's key proposals on health reform.

One of Obama's ideas was to expand eligibility for Medicaid, a public health insurance program primarily for pregnant women, children and the disabled. The House bill expands Medicaid eligibility to poor adults, which it defines as nondisabled, childless adults under age 65 with income at or below 133 percent of federal poverty level, about $14,400 per year for an individual.

We should be clear that there's a long way to go — maybe months — before this bill becomes law. It has to get through the Senate, where many an ambitious House bill has seen its hopes dashed.

Nevertheless, the bill marks significant, measurable progress on Obama's promise, and we rate it In the Works.