In the states that have not expanded Medicaid, there's a coverage gap that leaves about 2 million people ineligible for any sort of affordable coverage. These people are not eligible for premium subsidies in the marketplace because their income is under the poverty level. But they are also ineligible for Medicaid because their states have refused to implement Medicaid expansion. According to US Census data, the percentage of people below the poverty level who are uninsured is more than twice as high in states that haven't expanded Medicaid, compared with states that have. To be clear, this is due to the decisions that their states have made, rather than a flaw in the ACA itself. The states could opt to accept federal funding to expand Medicaid at any time, thus closing the coverage gap. Five states — Texas, North Carolina, Florida, Georgia, and Tennessee — account for the lion's share of the coverage gap population, and they are among the 12 states where Medicaid expansion is still a contentious issue and the legislature and/or governor are still strongly opposed to accepting federal funding to expand Medicaid. (Note that North Carolina lawmakers might reach an agreement in 2022 that would allow the state to expand Medicaid). For people in the coverage gap who received unemployment compensation for at least one week in 2021, the American Rescue Plan provided eligibility for premium subsidies. But this was a temporary provision for 2021. The Build Back Better Act would have provided federal subsidies for four years to people in the coverage gap, allowing them to purchase premium-free coverage with enhanced benefits that leave them with very little out-of-pocket costs. That legislation passed the House in the fall of 2021, but stalled in the Senate due to objections from all GOP Senators as well as two Democrats. However, there have been ongoing negotiations in 2022 about a budget bill that might include federal funding to close the Medicaid coverage gap.