In this week’s opening of health insurance marketplaces (also called exchanges), many people are learning — unfortunately and ironically — that they don’t earn enough to qualify for help buying coverage. That’s because their incomes fall below the thresholds to qualify for premium subsidies, and they live in states that aren’t accepting federal funds to expand Medicaid to low-income, childless adults. Many of the states that aren’t expanding Medicaid are among those with the highest rate of uninsured adults (see charts, below).



A recent New York Times article illustrates the impact on some people who will remain uninsured unless their states expand Medicaid. For example, a 55-year-old woman finds she cannot qualify for coverage because she moved from Maryland — a state that is expanding Medicaid — to live with her brother in Virginia — a state that isn’t taking the expansion — after falling on hard times.



The Times article also confirms analyses by groups in Louisiana, Montana, Virginia and several other states showing that those falling in the coverage gap hold down jobs as cashiers, cooks, and construction workers. It doesn’t have to be that way for people in Mississippi, Texas, Virginia and the other states that haven’t yet taken the federal dollars to expand. Policymakers in the states that haven’t expanded yet should move quickly to fill this coverage gap.



