Nearly 5 million poor, uninsured adults will have no subsidized coverage options under the Affordable Care Act next year. Three-quarters of them live in the South and more than half are minorities, according a new report by the nonprofit Kaiser Family Foundation.

194,000: Uninsured adults in S.C. who will not qualify for Medicaid or a health insurance subsidy next year - commonly called the "coverage gap."

104,000: White S.C. residents who fall in the coverage gap.

83,000: Black S.C. residents who fall in the coverage gap.

Source: Kaiser Family Foundation

In South Carolina, 104,000 white adults and 83,000 black adults with very low incomes will not qualify for Medicaid or a subsidy to help pay for health insurance next year.

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South Carolina, like most other Southern states led by Republican governors, is not expanding Medicaid under the Affordable Care Act.

These residents who fall below 100 percent of the federal poverty level - less than $12,000 a year for a single adult - could pay the full sticker price for health insurance next year and would not be denied coverage, but this option is likely unaffordable for many in this "coverage gap."

"Given their high uninsured rates and low incomes, people of color will be disproportionately impacted by this coverage gap, particularly poor uninsured black adults residing in the Southern region of the country where most states are not moving forward with the expansion," the report's authors wrote.

"Those are our lowest income folks," said Shelli Quenga, director of programs for the nonprofit Palmetto Project. "I do have to tell people you're too poor for coverage in our state. That's a very hard conversation to have . There's nothing for them. You have to say it a couple of times because it doesn't make sense to people. How is it the poorest of the poor - we leave them out? It doesn't make sense."

More than 750,000 South Carolinians have no health insurance, according to the U.S. Census. The Kaiser Family Foundation estimates that 336,000 people in this state will qualify for financial assistance from the federal government to help pay for a policy.

S.C. Medicaid Director Tony Keck challenged the foundation's assertion that their reports are nonpartisan.

"They are so aligned with the Obama administration, very little of their work means anything to anybody anymore," said Keck, who opposes expanding Medicaid eligibility in this state.

He has frequently argued this year that there are less expensive ways to improve health than by expanding Medicaid.

"Health is much more complicated than health insurance," he said.

A full copy of the Kaiser Family Foundation report is available online,

Reach Lauren Sausser at 937-5598.