Obamacare is a national initiative, but it’s taking shape very differently in different parts of the country.

Only 10 states are implementing all three of the law’s main provisions—reforming insurance-industry practices, creating state-based marketplaces for health coverage, and expanding access to Medicaid. Yet nearly all states have embraced parts of the law.

The accompanying chart, based on a new report from the Commonwealth Fund, shows how different parts of the law are faring nationwide. Here are some of mixed-bag approaches states are taking to health care reform:

Fully on board

Ten states—California, Colorado, Connecticut, Hawaii, Maryland, Massachusetts, Minnesota, New York, Oregon, and Vermont, as well as the District of Columbia—are fully on board. They’ve set up their own insurance marketplaces, expanded Medicaid coverage, and enacted most or all of the law’s insurance-industry reforms.

Insurance reform only

Thirty-two states and Washington, D.C. are helping the feds enforce at least one of Obamacare’s insurance reforms, such as family coverage for kids under 26, no penalties for pre-existing conditions, and essential benefits in all health plans. Three of those states—Maine, South Dakota, and Virginia—are fully implementing the insurance reforms even as they decline to expand Medicaid or manage their own health insurance marketplaces.

Medicaid but no marketplace

Of the 34 states that aren’t running their own insurance exchanges, 11 are opting into the Medicaid expansion. Those states are Arizona, Arkansas, Delaware, Illinois, Iowa, Michigan, New Jersey, North Dakota, Ohio, Pennsylvania and West Virginia.

Marketplace but no Medicaid

Of the 24 states that haven’t yet expanded their Medicaid programs, just one—Idaho—is running its own health-insurance marketplace.

Complete obstruction

Five states—Alabama, Missouri, Oklahoma, Texas, and Wyoming—have refused to play any role in implementing the health care law.