(Bloomberg) -- About 5.2 million Americans will be left without health coverage because of the decision by 26 U.S. states to reject expanded Medicaid insurance programs for the poor with money provided under Obamacare.

Alabama, Louisiana, Mississippi and South Carolina will be particularly hard-hit, as those southern states will fail to provide coverage to at least one-third of uninsured adults, according to a report from the Kaiser Commission on Medicaid and the Uninsured. In Texas, more than 1 million people won’t have access to insurance provided through the Patient Protection and Affordable Care Act of 2010, while 763,890 Floridians won’t receive health coverage.

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