Just four states have 61 percent of the roughly four million people in the Medicaid gap, the Kaiser Family Foundation finds in its latest Medicaid survey. As of March, 2015, when KFF completed the report, 22 states were still refusing to take the expansion of Medicaid under Obamacare. (Since then, the Montana legislature broke a logjam and voted to expand. The state will still need the Obama administration to sign off on the plan.) But just four southern states—Florida, Texas, Georgia, and North Carolina—have the majority of people who remain without coverage. And it's people in the South who are predominantly left out.
The geographic distribution of the population in the coverage gap reflects both population distribution and regional variation in state take-up of the ACA Medicaid expansion. As a whole, more people—and in particular more poor uninsured adults— reside in the South than in other regions. Further, the South has higher uninsured rates and more limited Medicaid eligibility than other regions. Southern states also have disproportionately opted not to expand their programs, and half (11 out of 22) of the states not expanding Medicaid are in the South. These factors combined mean 89% of people in the coverage gap reside in the South. […] Several states that have large Hispanic populations (e.g., California, New York, and Arizona) are moving forward with the expansion, while other states with large Black populations (e.g., Florida, Georgia, and Texas) are not. As a result, Blacks account for a slightly higher share of people in the coverage gap compared to the total poor adult uninsured population, while Hispanics account for a slightly lower share. The racial/ethnic characteristics of the population in the coverage gap vary widely by state, mirroring the underlying characteristics of the state population. […] Nonelderly adults of all ages fall into the coverage gap. Notably, over half are middle-aged (age 35 to 54) or near elderly (age 55 to 64). Adults of these ages are likely to have increasing health needs, and research has demonstrated that uninsured people in this age range may leave health needs untreated until they become eligible for Medicare at age 65.
Southerners would also be disproportionately hit if the Supreme Court rules in the King v. Burwell case that people buying Obamacare insurance on the federal exchange aren't eligible for subsidies. Between already high uninsured rates and the potential for all those people to lose their new insurance, the South will sink further and further behind the rest of the nation on healthcare and health outcomes. Case in point, Florida, where there are roughly 669,000 people in the gap and where Gov. Rick Scott is suing the federal government to try to avoid having to take the Obamacare Medicaid money and still keep his state's hospitals—and finances—afloat. There's a simple solution to all of this. Take the damn free money and start getting people covered.