The disproportionate impact on poor blacks introduces the prickly issue of race into the already politically charged atmosphere around the health care law. Race was rarely, if ever, mentioned in the state-level debates about the Medicaid expansion. But the issue courses just below the surface, civil rights leaders say, pointing to the pattern of exclusion.
The law was written to require all Americans to have health coverage.
For lower and middle-income earners, there are subsidies on the new health exchanges to help them afford insurance.
An expanded Medicaid program was intended to cover the poorest.
The Supreme Court’s ruling on the health care law last year, while upholding it, allowed states to choose whether to expand Medicaid.
Every state in the Deep South, with the exception of Arkansas, has rejected the expansion.
The federal government provided the tally of how many states were not expanding Medicaid
It included states like New Hampshire, Ohio, Pennsylvania and Tennessee that might still decide to expand Medicaid before coverage takes effect in January.
Opponents of the expansion say they are against it on exclusively economic grounds, and that the demographics of the South — with its large share of poor blacks — make it easy to say race is an issue when it is not.
Poor people excluded from the Medicaid expansion will not be subject to fines for lacking coverage. In all, about 14 million eligible Americans are uninsured and living in poverty, the Times analysis found.
Those that opted not to leave about eight million uninsured people who live in poverty ($19,530 for a family of three) without any assistance at all.
In all, about 30 million uninsured Americans were to have become eligible for financial help.