8 health insurance reform winners and losers

LOSER: The poor without expanded Medicaid
LOSER: The poor in states not expanding Medicaid © alexmillos/

The Supreme Court decision in 2012 that upheld the Affordable Care Act allowed states to decide for themselves whether to expand Medicaid. Half the states have rejected the idea or have delayed their decision.

"The biggest 'supposed-to-be winners' will end up losers if they live in a state where Medicaid hasn't been expanded," says Jost, of Washington and Lee University. "In those states … if their income is too low for the health insurance exchanges and they don't meet Medicaid standards, they have no access to health insurance."

Generally, if people earn 100 percent or less of the federal poverty level (currently $11,490 for an individual) they won't qualify for either Medicaid or the Obamacare tax credits on the health exchanges and are unlikely to be able to afford health insurance.

"There are 1 million uninsured in Texas alone that are under the poverty limit but without the tax credit. They won't be able to afford the plans on the exchanges and yet won't qualify for Medicaid," says Gruber.


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