So when does a philosophical opposition to the Affordable Care Act – President Barack Obama’s signature health care law – become a real-life issue for families? 
Especially for people who have paying jobs, such as cooks, waiters, butchers and janitors?
Try when adults can’t afford health insurance for themselves or loved ones – and illness never takes a day off. The reasons for this predicament: Certain jobs don’t pay enough money and governors and state lawmakers have declined to accept federal dollars to expand Medicaid, the safety net program that provides health care access for low-income families.
A report released Wednesday shows that Alabama is home to nearly 185,000 working adults who are caught in this “Medicaid coverage gap,” Arise Citizens’ Policy Project (ACPP) and Families USA reported. In total, though, the number of low-income Alabama residents who lack health care insurance is 342,000, an amount that includes children.
“These are the people all around us who keep things going,” Jim Carnes, ACPP policy director, said in a statement.
“They often struggle to work while health problems sap their productivity, add stress to their households and get worse without timely care. Imagine what a difference regular health care could make for families’ lives, for our workforce and for our economy.”
Under the Affordable Care Act, the federal government is offering money to states to expand the program. But in 2012, the U.S. Supreme Court ruled that states are not required to participate in the Medicaid program. Instead, they have the option to do so.
Many states decided to sit on the sidelines, often for philosophical opposition to the law or because of questions about cost.
As a result, the coverage gap has emerged.
In Alabama, ACPP and Families USA said, the gap is swallowing up about 52,000 food service and construction workers; 45,000 people working in the sales, cleaning and maintenance industries and 48,000 adults who are employed in production, administrative and transportation jobs.
About 40,000 adults – working in child care, repair jobs and various other ones – also find themselves in this health insurance gap.
ACPP said that if state leaders close the gap, residents with incomes up to $27,310 (for a family of three people this year), or which is 138 percent of the federal poverty level, could gain health insurance.
Arise Citizens’ Policy Project, based in Montgomery, Ala., is a coalition of more than 140 groups and congregations working on public policies to help low-income residents.