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Medicaid coverage was different in each state, and many low-income families didn't have enough access to it. Despite some progress, there were still big problems. In the late 20th century, as healthcare costs went up and more people became uninsured, there were calls to change things. Medicaid's coverage varied widely by state, leaving many low-income families without sufficient access. Despite these advancements, significant gaps remained. By the late 20th century, raising health care costs and an increasing number of uninsured Americans prompted calls for reform.