HOLLY SPRINGS, Miss. — Darlene Velasco can’t afford to treat her Type 2 diabetes. She doesn’t make enough money at her job selling college sports memorabilia to pay for medication or private health insurance and, at $13.50 an hour, earns too much to qualify for Medicaid.

That’s been the case for years and without treatment, Velasco, 45, was declared legally blind in May. The disease built up cataracts in her eyes and when her vision began to blur and disappear, she found herself driving to her job that carries no health benefits steered only by the memory of the backcountry roads that surround her home.

“I reached out to everybody I could, asking about programs for people who can’t afford medical insurance — hardworking people,” she said late one October night, deep in this Mississippi hill country. “Not everyone has that financial stability with benefits. Some of us get our paycheck biweekly, struggle to make ends meet, pay rent and raise kids. It’s not easy.”

Mississippi is one of 14 states that chose not to expand Medicaid, forgoing about $1 billion from the federal government each year since 2012 when the Affordable Care Act offered states the opportunity to expand care.

The states that choose to go along with the program, first rolled out under the ACA, will eventually have to provide a 10 percent match of the funds by 2020. That would cost Mississippi about $100 million a year, and Republican lawmakers insisted it would be detrimental to the state economy.

In Mississippi, a state that has one of the highest uninsured rates in the country — currently ranked at 45 out of 50 — about 100,000 people fall in the same coverage gap as Velasco, according to the Kaiser Family Foundation. In total, 2.5 million poor adults fall into that same gap in the 14 states that did not expand Medicaid.

Meanwhile, health care costs continue to grow, creating a core campaign issue in Mississippi’s gubernatorial election that will be decided Tuesday. State Attorney General Jim Hood, a Democrat, supports expansion to address costs, while Republican Lt. Gov. Tate Reeves opposes it.