Paying huge sums of money out of one's own pocket for medical expenses—especially when uninsured—is the leading cause of personal bankruptcy in the U.S., according to the Kaiser Family Foundation. And even after the implementation of the Affordable Care Act, millions remain uninsured—15.5 percent of working-age (19-64) Americans this year, so says a study by the Commonwealth Fund. With the ACA still in place but uninsured rates rising, WalletHub measured the uninsured rates in each of the 50 states. The customized financial advice site compared the rates for 547 U.S. cities and the 50 states, in addition to a breakdown by age, race/ethnicity and income level. Related: Number of uninsured children has fallen by 38 percent Here is a look at the 10 states with the highest uninsured rates—with a discussion on why they did or did not choose to expand Medicaid under the federal law. Those decisions created a "coverage gap"—individuals ineligible for Medicaid under its previous rules, but too poor to qualify for the ACA's subsidies and credits. Indeed, the resulting coverage gap was the biggest mistake during the drafting of the ACA, according to the publication, Governing. Under the law, Americans with an income below 138 percent of the federal poverty level qualify for Medicaid—but Americans with an income of 100 percent of the federal poverty level and above (up to 400 percent) qualify for federal tax subsidies to purchase private insurance on the exchanges. "Back in 2009, early versions of the Senate's health reform bill included what was known as a Bridge Policy: people between 100 percent and 138 percent of the federal poverty level could choose whether they wanted to enroll in Medicaid or go through the marketplaces and purchase private insurance with a federal tax subsidy," Governing writes. However, once the Congressional Budget Office came back with estimates of the bill's costs, Senate staff decided the Bridge Policy was too costly to keep in the bill, a staffer told the publication. The Bridge Policy was eliminated when the Finance Committee bill merged with the health reform bill from the Health, Labor, Education and Pensions committee, and a "manager's amendment" reworked the bill sent to the Senate floor—but "unintentionally" failed to revise the subsidy threshold from 100 to 138 percent, the source said. The explanation? The Bridge Policy and the tax subsidy section of the Senate Finance bill were separated by more than 100 pages—and when one section was changed, nobody remembered to check the other. "I don't want to imply that people were being sloppy. But when you take out the Bridge Policy, you've got to check in 20 different places to make sure everything matches," one Senate staffer told Governing. "This stuff was happening so quickly, and, at the end, it was quite messy." Read more: |

• More skip care in states lacking Medicaid expansion
• 4 reasons employer-sponsored health insurance won't go away
• Soaring health insurance premiums spark grassroots activism