Ever since the Affordable Care Act started to be debated in Congress, Republicans and conservatives have made it their goal to fight against all forms of the act. Unfortunately, their refusal to actually help improve the act has allowed it to be rather inadequate in many different ways.

After the Supreme Court decision regarding the Affordable Care Act, states were no longer required to expand their Medicaid programs, which were fully funded under the bill. As a result of this ruling, Republican governors and legislators have fought against that expansion and prevented it from being implemented in 26 different states.

Originally, the Democrats in Congress as well as the president aimed to write a health care reform that would cover all Americans, but Obamacare and the result of the Supreme Court case have left a plan that is far from universal. Twenty-six states – including almost all of the Southern states, with the exception of Arkansas – have elected to refuse to expand Medicaid.

This is despite the fact that the expansion will be covered entirely by the federal government until 2016 and at least 90 percent in the years afterward. As a result of this decision not to expand Medicaid, millions of Americans have been added to those who were not going to get insurance under the new laws anyway.

The poor in states that have not expanded Medicaid are stuck between a rock and a hard place. They do not qualify for the exchanges because they were originally going to be covered under Medicaid but they continue to not have health insurance so health issues are still going to be extremely trying on their incomes and bodies. According to the New York Times, around 14 million people would not be covered if the 26 states that have rejected the expansion continue to do so until Obamacare is fully implemented in 2014.

The states that have rejected the Medicaid expansions are possibly some of the worst that could have rejected it as well. These states that have rejected the proposal, despite only being around half the U.S. population, are about 68 percent of poor, uninsured black citizens and single mothers. They also contain about 60 percent of the country’s uninsured working poor, meaning the people the law intended to help are being left out of it.

The failure to expand Medicaid in these states almost entirely falls upon the Republican legislatures and governors, but that only tells part of the story regarding Obamacare. If the health care reform bill had been truly universal through a system such as Medicaid for all, then there would not be the issue of millions of poor Americans being added to the rolls of people that Obamacare was already going to have uninsured. We would also not be worrying about whether the uninsured will continue to increase the cost of health care due to their inability to pay for it.

Matthew Bailey is a second-year law student. His column runs biweekly on Mondays.