State Medicaid choice affects 11.5 million uninsured adults below the poverty line

The healthcare reform law's Medicaid expansion would provide coverage to roughly 11.5 million adults who live below the poverty line but are currently ineligible for the safety-net insurance, the Urban Institute estimates. But should states choose not to expand Medicaid, those adults would be left out of the reform law's push to reduce the number of uninsured.

With income below the poverty line, they would be paradoxically too poor to qualify for subsidies under the law to buy commercial health plans. Those subsidies are available for those with income above the poverty line up to 400% of that threshold. (Not everyone will be able to hold on to subsidized insurance as income fluctuates with a change in jobs or hourly work schedules.)

For hospitals, fewer insured would undermine one proposed benefit of the Patient Protection and Affordable Care Act: fewer unpaid medical bills.

Here's a look at the states, ranked by the number of adults who are currently ineligible for Medicaid yet living below the poverty line, as estimated by the Urban Institute's Health Policy Center.

Source: Urban Institute

*Urban Institute researchers advise caution for Vermont's estimate of <1, which has a standard error of more than 30%.

You can follow Melanie Evans on Twitter: @MHmevans.