A dozen states Currently, twelve states have not expanded Medicaid. Texas, Florida, and Georgia are the most populous, but there are a few outside of the South, including Wyoming and Kansas. More than 2 million people in the United States have no choice when it comes to health insurance. These people can be classified as being uninsured. The federal government will not pay for any state that refuses to expand Medicaid. This means that if Alabama or Alaska decides not to participate, their residents will not be covered. The reason many states have refused to expand Medicaid is because the federal government will not cover any costs that arise from new expenses or increased spending. However, any state that reduces its funding now will not be required to continue to do so going forward. Because of this lack of protection, many states have decided that they cannot afford to expand Medicaid. They believe that if something happens to their current system, their families will be able to access adequate care through other channels. For example, some states may choose to fund emergency rooms at hospitals across the country. This way, if someone needs medical attention and can't pay, their family will not be denied care. Other states may choose to protect themselves by only covering certain types of care or limiting how much providers can charge for services. Because these policies would be difficult or impossible to enforce, few states have taken this approach.