Once the court struck down the mandate to expand Medicaid, poor workers in states that elected not to broaden their programs had nowhere to turn, the commission said in its report. They don't earn enough to get the tax credits and they aren't poor enough to qualify for Medicaid under the current eligibility level, which is a median income of about $9,400 a year for a family of three. The ACA would have allowed Medicaid benefits for families of three with incomes of about $27,000 annually.
Workers who fall into the gap are unlikely to be able to afford the cost of buying a health plan on their own. The average premium for a 40-year-old buying insurance through a national exchange is about $224 per month for a bronze plan, roughly half the monthly income for those at the lower end of the range, according to the report.
"People in the coverage gap are likely to face barriers to needed health services or, if they do require medical care, potentially serious financial consequences," the commission concluded in the report. "Further, the safety net of clinics and hospitals that has traditionally served the uninsured population will continue to be stretched in these states."
Mississippi leads the nation in the percentage of uninsured adults in the coverage gap with 37 percent, followed by Alabama with 36 percent, Louisiana at 34 percent and South Carolina at 33 percent.
With 1 million uninsured in Texas, the state has the largest number of people without access to health insurance, representing a fifth of U.S. citizens without coverage. Florida has the second highest.