It's understood that people earning less than 133% of the federal poverty level in 2014 will qualify for Medicaid, while people making between 100% to 133% of the federal poverty level are eligible to purchase subsidized insurance coverage through the state marketplaces if they are not eligible for Medicaid.
Here is where it gets skewed: People making less than 100% of the poverty level in the 26 states are not eligible for marketplace subsidies because it was assumed that they would be enrolled in Medicaid.
As a result, Collins says, not only will the lowest-income people be unable to enroll in expanded Medicaid, but they won't be able to purchase subsidized health insurance through the marketplaces.
The Commonwealth Fund estimates that the glitch will affect two-in-five adults who live in the 26 states and who were uninsured any time over the two-year survey period earned less than the federal poverty level in one or both years. The report also finds that low-income people in the 26 states could lose coverage if their income changes.
For example, one year a family's income level could qualify them for subsidized coverage through the marketplaces. However, an income loss, such as that resulting from the loss of or change in a job, could drop them into the category where they no longer qualify to purchase subsidized coverage through the marketplaces. With no expanded Medicaid and no option for subsidized coverage through the marketplaces, they would likely become uninsured.