Study: 11.5 million who could lose Medicaid wouldn't get subsidies, either

States's decisions to opt out of the Medicaid expansion in President Obama's healthcare law will deny millions of people access to affordable coverage, according to an analysis by the Urban Institute.

The Supreme Court ruled that states must have the option to opt out of the expansion without losing all of their federal Medicaid funding. Seven states have said definitively that they won't participate, and another eight are leaning against it.

The Affordable Care Act expanded Medicaid eligibility to people whose incomes fall below 138 percent of the federal poverty level. The law also provides subsidies to buy private insurance, but only to people at or above 100 percent of the poverty line.

So people whose incomes fall between 100 percent and 138 percent of poverty are caught in the middle — they're not eligible for subsidies, but they might not be able to get Medicaid, either, if their state opts out of the expansion.

Nationwide, about 11.5 million uninsured people fall into that category, the Urban Institute said. Roughly 1.8 million live in the seven states that have said they won't take part in the Medicaid expansion.

Some of those people might be eligible for Medicaid already, but aren't enrolled. And not all 11.5 million will have to go without coverage, because several states -- 12 so far -- plan to implement the new expansion anyway.

The federal government will initially cover the entire cost of the expansion, dropping to 90 percent after the first few years.

States challenged the policy as coercive, saying they shouldn't have to sacrifice their entire Medicaid programs just because they don't want to expand the program further.

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