People below the poverty level will have no new coverage options under the Patient Protection and Affordable Care Act in states that don't expand their Medicaid programs, according to a new study.

As many as two of five recently uninsured adults in those states likely will have no new affordable health insurance options next year, says a new Commonwealth Fund report.

That's because 26 states have decided either not to expand their programs or remain undecided, meaning many below the poverty line won't have access to either the Medicaid expansion or subsidized private insurance through the new state insurance marketplaces and probably will remain uninsured.