The refusal to expand Medicaid or implement the Affordable Care Act has dealt a devastating blow to low-income families in the South, including many living in rural areas and counties. Although about one-third of Southerners are unlikely to have health insurance, Alabama, Georgia, and Mississippi are among nearly a dozen states that have refused to expand Medicaid to move forward with the Affordable Care Act.

Without the Medicaid expansion, Medicaid eligibility levels for adults in the South remain low. Four-point eight million uninsured U.S. adults fall into the coverage gap, which would be alleviated by Medicaid expansion. Nearly 80 percent of these live in the South. In the South, African Americans are more likely to be impacted by the lack of Medicaid expansion than whites, 56 percent compared to 47 percent, respectively.