Any money that otherwise might be spent on a costly out-of-pocket appointment is saved up instead for yearly trips to El Salvador, where Claudia’s husband moved with four of their children after he was deported eight years ago. Claudia has been managing like this since 2007, the last time she had a permanent job that provided health insurance.

When Claudia first learned about the Affordable Care Act, she was hopeful that the law would portend what its name implies.

But a few months ago, she arrived at a community meeting at the Irving public library to find that because she makes less than the federal poverty level, she does not qualify for the federal government’s subsidies to buy insurance. (The subsidies to buy insurance on the newly created exchanges only go to people who make 100 percent of the federal poverty level or more.) Without the subsidy, the family’s premium for a mid-level “silver” health plan on the exchange would be roughly $5,000 per year.

If she lived in, say, California or Kentucky, Claudia could simply enroll in Medicaid. The Affordable Care Act provided for states to expand the program to include low-income adults — a demographic that in most states has been traditionally ineligible for Medicaid, which was designed for children and pregnant women.

But in its June 2012 Obamacare decision, the Supreme Court ruled that states aren’t obligated to expand Medicaid, and Texas is currently one of the 25 states that have chosen not to expand the program. In April, Texas Governor Rick Perry, a Republican, called Medicaid expansion “a misguided, and ultimately doomed, attempt to mask the shortcomings of Obamacare” and has resolutely refused to consider it.

“I found out that Rick Perry had denied Medicaid,” Claudia said. “And I thought, ‘What's going to happen with me now?’”

It’s a question many Texans are asking themselves as vague newscasts about coverage deadlines and website fixes have stirred increasing numbers to learn more about Obamacare—with some finding bad news about their own prospects under the law. Texas has the highest rate of uninsured people in the nation, at 25 percent. In all, 1,046,000 people will fall into the state’s so-called “Medicaid gap”: the expanse between the minimum salary necessary to qualify for a federal subsidy to purchase insurance on the new Marketplace, or about $11,500 a year, and the maximum wage to qualify for Medicaid, which in Texas is about $3,500 for a family of four. At a time when millions across the country are gaining health insurance, it’s estimated that Texas’ Medicaid gap will swallow up 91 percent of the poor, uninsured adults in the state.

Kaiser Family Foundation

Of all the people who fall into this coverage gap nationwide, more than a fifth reside in Texas — in part because it, like many other southern states, also happens to have super-stringent Medicaid requirements. Able-bodied adults under the age of 65 without children don’t qualify for the program at all unless they are pregnant.