I met a woman named Yvonne in Greenville , South Carolina , where the CNN Express was reporting on the rollout of Obamacare . Yvonne had a big smile and was very excited -- you could n't miss her . I first noticed her standing in line , waiting patiently to ask a few questions about health care . Most of the questions I had been asked up until that time revolved around the logistics of signing up , whether they could pick a particular doctor and how much all this was going to cost . Yvonne , who did n't give her last name , started by telling me that she had been able to get off Medicaid in the past year . Before that , she had been living in her car , intermittently staying with friends . Now she has a place to live , and she 's excited about the prospect of finally being able to get private health care insurance for the first time in her life . Yvonne , 35 , told me she works part-time as a hairstylist assistant . She said she makes $ 9 an hour , which at 20 hours a week works out to about $ 9,360 a year . She is still impoverished , but considers herself lucky because she 's never had a major illness . As we spoke about South Carolina 's sign-up process , I realized I was explaining some unwelcome news : Yvonne is not eligible for any assistance toward buying health insurance . Let me try to explain : In a state that has chosen not to expand Medicaid , Yvonne is in the staggering position of now making too much money to qualify for Medicaid , and too little to obtain subsidies through the Affordable Care Act . This was n't how it was supposed to go down for Yvonne and others like her all over the country . When you imagine the people likely to benefit the most from the Affordable Care Act , you probably think of someone just like her . By obtaining a real job with enough income , Yvonne has disqualified herself from her state 's Medicaid program . But in order to qualify for subsidies in South Carolina , she needs to get above the poverty line , and she is not quite there . Yvonne and an estimated 7 million others now find themselves in a coverage gap . The tax subsidies available through the health exchanges were intended to make private insurance coverage affordable for those between the poverty line and four times as much -- people who now shoulder the responsibility , by law , of purchasing their own coverage . Last year , in its landmark ruling that left most of the ACA in place , the U.S. Supreme Court ruled that the Medicaid expansion is optional for states . South Carolina , and 25 other states , turned it down . As a result , a big swath of the uninsured will stay that way when new coverage options kick in January 1 . I asked Kentucky Senate hopeful Matt Bevin , a Republican , who was against the expansion in his state , about this . Democratic Gov . Steve Beshear has been a proponent of the law , and Kentucky has expanded Medicaid to cover anyone making up to 138 % of the poverty line . When I described Yvonne 's situation to Bevin , he was sympathetic but immediately replied , `` Where is the money going to come from ? '' His is a common sentiment among leaders of states that have refused Medicaid dollars from the federal government . For the time being , the money comes from the federal government . In the states that accepted Medicaid expansion , the federal government will pick up 100 % of the tab for four years . For the next three years , it will pay for slightly less . Beyond 2020 it will cover 90 % of the cost . The man who oversees the health insurance expansion in Maryland , Dr Joshua Sharfstein , was stunned that so many states turned the money down . According to the analysis in Maryland , the economic benefits of Medicaid expansion would be in the billions . As I walked with him , I asked if he could give a single reason -- medically or financially -- for a state not to accept the Medicaid dollars . He thought about it for a moment , and said `` none . '' `` This is just politics , '' he added . Yvonne does n't have many options . She ca n't get subsidies , Medicaid or health insurance . One small solace is that she wo n't be forced to pay any tax penalty for not having insurance . `` Oh well , I guess that is good , '' Yvonne replied when I told her . She had worked so hard to come off Medicaid , but asked me at the end of the day for a list of states where she might move to get back on the Medicaid program once again .
Some earn too much money to qualify for subsidies , but not enough to obtain ACA benefits . 26 states decided not to expand Medicaid after the Supreme Court 's decision . Those who ' n't get Medicaid or who ca n't pay a fine for not getting health insurance .