(CBS NEWS) - Next year, the nation will be split: 25 states and the District of Columbia will expand Medicaid coverage, while 25 states won't. In those states without expanded coverage, nearly five million people will be ineligible for Medicaid as it exists currently but will be too poor to qualify for subsidies on the new Obamacare marketplaces.
That so-called Medicaid coverage gap will mostly impact minorities, according to a new report -- particularly uninsured African-Americans living in the South -- and will likely widen the already-existing racial, ethnic and geographic disparitiies in health coverage.
The Kaiser Family Foundation's Commission on Medicaid and the Uninsured reports that of the 4.8 million uninsured adults in the "coverage gap," nearly 2.6 million (53 percent) are racial or ethnic minority groups. Twenty-seven percent of the uninsured in the gap are black, 21 percent are Hispanic, 47 percent are white, and 5 percent are other races.
Among all uninsured blacks with incomes low enough to qualify for the expanded version of Medicaid, 40 percent fall into the gap -- compared with 24 percent of uninsured Hispanics and 29 percent of uninsured whites.
Already, minorities are more likely to be uninsured (27 percent) than whites (15 percent), with Hispanics at the highest risk of lacking coverage (33 percent). That gap makes the expansion of Medicaid particularly important for people of color.
Currently, Medicaid exists as a joint federal-state program that provides health care to certain poor Americans, such as children and the elderly. As it was passed in 2010, Obamacare required all states to expand Medicaid so that it's available to anyone with an income under 138 percent of the federal poverty line.
However, the Supreme Court ruled in 2012 that the Medicaid expansion was optional; so far, 25 states and the District of Columbia have decided to expand, and the remaining 25 states haven't. There are subsidies available for consumers on the new Obamacare marketplaces -- but only for those with an income at or above 100 percent of the federal poverty line. This has led to the Medicaid "coverage gap."
President Obama has railed against states that have opted out of the Medicaid expansion, such as Texas. "Across this state, you've got a million people -- because this is a big state -- a million people, citizens, who don't have health insurance who get insurance right away," Mr. Obama said at a stop in Dallas last month.
More than a fifth of people in the coverage gap reside in Texas, according to Kaiser. In fact, nearly nearly 80 percent of people in the coverage gap reside in the South. African-Americans are harder hit by the coverage gap than Hispanics, the report shows, since several states with large Hispanic populations -- including California, New York and Arizona -- have opted to expand Medicaid.
By Stephanie Condon CBS News