A New York Times map detailing the varying rates of uninsured people across the country shows striking similarities to the distribution of people living with HIV, particularly in the Deep South. The Times paired with Enroll American and Civis Analytics to determine the changing rates of Americans with insurance in respective counties since the Affordable Care Act’s (ACA, or Obamacare) marketplace plans and Medicaid expansion began in January 2014.

The Times found that the bulk of the remaining uninsured Americans live in the Southwest and South. Over the past two years the uninsured rate has dropped below 10 percent in the Northeast and upper Midwest.

While HIV is highly prevalent throughout the Eastern Seaboard, California, and in major urban areas like Chicago, it has cut a particularly devastating swath across the South. Low insurance rolls may challenge efforts to combat the spread of HIV through a “test and treat” protocol: improving diagnosis rates, and getting diagnosed people more quickly into care, retained in care, and adhering well to antiretrovirals, fully suppressing their virus and vastly reducing the likelihood that they will transmit it to others..

A major likely cause of the regional differences in insurance rates is whether state governments have opted to expand Medicaid—by and large, Democratic legislatures and governors have done so, while Republican-controlled state governments have held back, or have been late to the party. Red states tend to have higher uninsured rates, but also were more likely to have had high rates before 2014.

According to The Times, more than 3 million people in 19 states exist in the “Medicaid gap”: They make less than 100 percent of the federal poverty level, which, due to a glitch in the law, disqualifies them for the federal subsidies that would likely make a private marketplace plan affordable; yet because their state has not expanded Medicaid, they still cannot qualify for that program.

To read the New York Times article, click here.