An article in Sunday’s Charlotte Observer describes a large segment of North Carolinians who fall into a gap of fear about their health coverage. Talking about coverage from the Affordable Care Act, or ACA, the article says, “In general, lower income means a higher subsidy.”

“But for those who hover around the poverty line, a slump can put them into the ‘no help’ category in the Carolinas and 21 other states that haven’t expanded Medicaid coverage,” is says.

At least 575,000 North Carolinians are in a health care coverage gap, says The Observer.

A handful of states that rejected the Medicaid expansion have created their own ways to offer coverage. Arkansas, Iowa and Pennsylvania, for instance, got approval to use the federal expansion money to create their own subsidies for people in the gap to buy private policies.

It’s unclear whether North Carolina will follow suit. State leaders say some type of Medicaid reform will be on the agenda when the General Assembly convenes Jan. 14. Gov. Pat McCrory and departing House Speaker Thom Tillis have indicated interest in finding ways to extend coverage, while Senate President Pro Tem Phil Berger says he hasn’t changed his stance on rejecting the federal money.

If North Carolina does nothing, it will forego almost $40 billion in federal money for Medicaid expansion over the next decade, while saving just over $3 billion in state costs for expansion, according to a recent study by the Robert Wood Johnson Foundation. Meanwhile, state taxpayers will kick in about $10 billion in federal tax hikes designed to pay for the expansion without reaping any benefit.