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As initially passed, the ACA was designed to provide universal health care in the U.S.: those with employer-sponsored health insurance would keep their plans, those with middle-income and lacking employer-sponsored health insurance could purchase subsidized insurance via newly established health insurance marketplaces, and those with low-income would be covered by the expansion of Medicaid.
But a crucial Supreme Court ruling in 2012 granted states the power to reject the Medicaid expansion, entrenching a two-tiered health care system in America, where the uninsured rate remains disproportionately high in mainly Republican-led Southern and Southwestern states.
2.6 million were in the "coverage gap" due to the 19 states that chose not to expand the Medicaid program under the ACA/Obamacare, meaning their income was above the Medicaid eligibility limit but below the threshold for subsidies on the ACA exchanges (~44% to 100% of the federal poverty level or FPL); 5.4 million were undocumented immigrants;
Several states have trigger laws where if federal funding drops, so would Medicaid expansion. NC 1 of 9 states that could halt Medicaid expansion if Trump cuts funding Skip to main content
[citation needed] The Kaiser Family Foundation estimated in October 2015 that 3.1 million additional people were not covered because of states that rejected the Medicaid expansion. [215] [216] In many states income thresholds were significantly below 133% of the poverty line. [217]
In states with expanded Medicaid, almost all adults with incomes up to 138% of the federal poverty level can benefit from the public insurance provision. So far, 38 states and Washington, D.C ...
Gov. Kim Reynolds' bill would extend Medicaid coverage to low-income mothers, but Iowans with higher incomes would be dropped.
The Kaiser Family Foundation estimated in October 2015 that 3.1 million additional people were not covered because of 19 states that rejected the Medicaid expansion in the wake of a 2012 Supreme Court decision that preserved their existing Medicaid funding whether or not they expanded coverage. [57]