Four out of every 10 uninsured Americans live in states that have chosen not to expand Medicaid under Obamacare and have incomes below the threshold for gaining the state-federal health benefits under President Obama's reforms.
The Robert Wood Johnson Foundation said Tuesday that 40.8-percent figure compares to 24.4 percent of uninsured adults who have low incomes but live in states that did expand the program.
"At least for now, it would appear that geography is destiny for a large number of low-income, uninsured Americans," said Katherine Hempstead, of the foundation. "The increasing proportion of the remaining uninsured residing in states that have not yet expanded Medicaid will certainly impact the extent of further increases."
Since the Supreme Court made it optional in 2012, only 26 states and the District of Columbia have opted to expand Medicaid to those making up to 138 percent of the federal poverty level. Although the federal government picks up the lion's share of the costs, particularly in the short term, opponents of expansion cite state burdens down the road and existing problems with the program.
Congressional Democrats are increasingly calling on Republican leaders to expand Medicaid, pitching it as an economic boon for their states and a matter of life and death for uninsured residents who stand to gain coverage.
Beyond the Medicaid-expansion group, the RWJF study found that 58.5 percent of the remaining uninsured population has heard about the new health insurance exchanges, but less than 40 percent know about government subsidies that make coverage more affordable for people earning 100-400 percent of the poverty threshold.
About six in 10 people uninsured people cited cost as the reason they do not have coverage, the foundation said.
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