It didn’t get much national attention when it was being created by 25 states that rejected the Affordable Care Act’s Medicaid expansion, but the gap swallowing up people too poor for exchange purchasing subsidies and too “wealthy” to qualify for Medicaid–which I called the “wingnut hole” to underline its origins in fanaticism–is now becoming very real. TPM’s Dylan Scott looks at the problem from the point of view of the “navigators” helping people figure out the new system:

According to the Kaiser Family Foundation, 38 percent of the U.S. uninsured have an income that’s below the poverty line — the population that won’t qualify for either Medicaid expansion or any financial help to purchase private coverage through the law in non-expanding states. About 5 million people fall in that gap in those states.

But these people probably don’t know that when they walk into a navigator’s office or attend an outreach event. They just want to find out what options are available to them — though it turns out the answer is not many….

“It’s awful,” one navigator in a non-expanding state said. “It’s basically: ‘Here are the really great options, and you can’t have them.’”

The realization that legislators and/or governors in 25 states turned down an almost entirely federally funded Medicaid expansion because they wanted to create this unconscionable situation ought to produce some electoral consequences in 2014, at the very least in the form of higher turnout among those directly targeted. If I were involved in Democratic GOTV efforts next year, I’d sure mention it, a lot.

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Ed Kilgore is a political columnist for New York and managing editor at the Democratic Strategist website. He was a contributing writer at the Washington Monthly from January 2012 until November 2015, and was the principal contributor to the Political Animal blog.