The Looming Health Care Reform "Donut Hole" There may be unintended consequences of the Patient Protection and Affordable Care Act (PPACA) – a new "donut hole" for low-income Americans in states that did not expand Medicaid as part of health care reform. Uninsured Adults With Incomes Below 100% of FPL (numbers in 1,000’s) In States Without PPACA Medicaid Expansion In 2014 State Uninsured "Donut Hole" Alabama 254 Alaska 29 Florida 994 Georgia 534 Idaho 79 Indiana 288 Iowa 80 Kansas 103 Louisiana . . .
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