States saying no to health law could see downside

States that reject the law’s Medicaid expansion risk leaving behind many of their low-income uninsured residents in a coverage gap already being called the new "doughnut hole"—a reference to a Medicare gap faced by seniors. If every state were to reject that Medicaid expansion—as the Supreme Court ruling now allows—some low-income people would still be picked up by other coverage provisions meant to help the middle class. But nearly 11.5 million uninsured people below the federal poverty line would be left behind in a new coverage gap, according to recent estimates from the Urban Institute.