The uneven progress could have consequences, including disparities and delays among states in carrying out an expansion of health insurance.

13 states have adopted a plan. 17 more 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.

Those lagging states include four with arguably the most to gain: Ohio, Texas, Florida and Georgia. The nonpartisan Urban Institute estimates those states together would add more than 7,000,000 people to the insurance rolls, reducing the annual burden of charity care by $10.7 billion.

Lt. Gov. Mary Taylor, who also heads the state insurance department, calls the findings from consulting firm Milliman Inc. alarming. The Republican Taylor says the law will have widespread and expensive impacts.

Taylor is Ohio’s point person on implementing the new health care law, and its advocates complain that her statement was overly partisan. Cathy Levine of the group Ohio Consumers for Health Coverage says consumers can have no expectation that Taylor is working on their behalf.

The court’s decision clears the so-called Health Care Freedom Amendment for the Nov. 8 ballot.

Progress Ohio had argued that Secretary of State Jon Husted counted petition signatures that should have been rendered invalid on technicalities.

Husted said the challenge revolved around petitions carrying extra information, a practice government should not discourage.