"A primary goal of the Affordable Care Act is to provide health insurance coverage to the millions of uninsured people in the U.S., the majority of whom have low and moderate incomes and struggle to afford the health insurance and healthcare they need," Commonwealth Fund Vice President and study coauthor Sara Collins said in prepared remarks. "However, if states don't expand their Medicaid programs, adults with the lowest incomes will continue to live without the health and financial security provided by the Affordable Care Act."
The report, In States' Hands: How the Decision to Expand Medicaid Will Affect the Most Financially Vulnerable Americans [PDF] , is based on a survey of U.S. adults ages 19 to 64 that estimated that 55 million Americans were uninsured at least part of the time from June 2010 to September 2012. In the 26 states, 72% of adults whose incomes fell below 133% of the federal poverty level ($14,856 for an individual and $30,657 for a family of four in 2012) during the two-year period were uninsured at some point.
In a perverse twist of the ACA, Collins says that some of the lowest income adults, the very people for whom the programs are designed, will be especially at risk in the states that don't expand their Medicaid programs.