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As a result, Blacks account for a slightly higher share of people in the coverage gap compared to the total poor adult uninsured population.

The racial/ethnic characteristics of the population in the coverage gap vary widely by state, mirroring the underlying characteristics of the state population (Table 1).

As a result, nearly nine in ten people in the coverage gap reside in the South (Figure 2).

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While the Medicaid expansion was intended to be national, the June 2012 Supreme Court ruling essentially made it optional for states.

This brief presents estimates of the number of people in non-expansion states who could have been reached by Medicaid but instead fall into the coverage gap, describes who they are, and discusses the implications of them being left out of ACA coverage expansions.

An overview of the methodology underlying the analysis can be found in the Methods box at the end of the report, and more detail is available in the Technical Appendices available here.

Nonelderly adults of all ages fall into the coverage gap (Figure 3).

Notably, over half are middle-aged (age 35 to 54) or near elderly (age 55 to 64).

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