On Thursday, the U.S. Supreme Court voted to uphold the overhaul of U.S. healthcare. However, its decision has caused doubt as to whether the upheld plan that is to extend coverage to over 30 million Americans who are uninsured, would reach the Americans who are the poorest.

The court, in its ruling, allowed states to not accept the Medicaid benefits expansion for low earners with household incomes of approximately $30,000. The current threshold for Medicaid varies depending on location, but in 33 of the 50 states, it is less than the $22,000 per household that defines the poverty line.

Officials in states opposed to the health law instituted by President Obama, such as Virginia and Texas, said they would study the new ruling and were undecided still on how they would proceed on the provision for Medicaid. Scott Walker, the Governor of Wisconsin said his state would no implement the law and hoped the November elections would create a majority in Congress for the Republicans so they could repeal the law.

Other state officials said they would probably limit expansion, a decision that could deny insurance coverage to a large percentage of the nearly 16 million people who just became eligible to receive Medicaid.

Tate Reeves the Lieutenant Governor of Mississippi said that expanding the program of Medicaid would add over 400,000 enrolled in the state and cost Mississippi over $1.7 billion during the next decade. Rick Scott, the Governor of Florida, said that expanding Medicaid in his state would devastate the economy.

Each state has different eligibility requirements, with some limiting coverage to pregnant women and families with children, while other states have extended the coverage to all those living close to the poverty line.