New data released by the U.S. Census Bureau’s American Community Survey shows that seven out of eleven major metropolitan areas with rates of uninsured people higher than the national average are in states that have refused to expand Medicaid under the Affordable Care Act (ACA).

Twenty-three states have rejected expanding Medicaid under the ACA, many of them with Republican-controlled legislatures and all but one with Republican governors. Several of the states are in the South, where all seven of the metropolitan areas with higher-than-average rates of uninsured people are found.

Florida is home to the city with the highest percentage of uninsured people in the nation, as 25 percent of Miami’s residents are without health insurance. Tampa Bay also makes the list with 15.1 percent of residents uninsured. Florida’s 20 percent uninsured rate is among the highest in the nation.

Florida will lose more federal dollars than any other state due to refusal by the GOP-controlled legislature to expand Medicaid, according to a joint report by the Robert Wood Johnson Foundation and the Urban Institute. The state will lose $66.1 billion in federal funding over the next decade.

In 2012 Florida Gov. Rick Scott (R) rejected Medicaid expansion. After Scott modified his position, the Florida legislature voted to reject it. It remains unclear whether Scott or Charlie Crist, his Democratic opponent in the gubernatorial campaign, will support implementing Medicaid expansion.

Texas is home to three of the cities with rates of uninsured people higher than the national average: San Antonio at 20.8 percent, Dallas at 21.5 percent, and Houston 22.8 percent. Texas has the highest percentage of uninsured residents in the nation; 22.1 percent of residents have no health insurance.

The high uninsured rate and the state’s failure to expand Medicaid has led to about one million residents falling into the so-called coverage gap.

A joint report by the Robert Wood Johnson Foundation and the Urban Institute also found that Texas has a projected loss over ten years of $65.6 billion in federal funds by not expanding Medicaid.

In 2012 Texas Gov. Rick Perry (R) refused to expand Medicaid, and then in 2013 the state legislature failed to pass the “Texas Solution,” a market-based version of Medicaid expansion. Arkansas, Iowa, Michigan, and Pennsylvania also created private health insurance exchanges in an effort to expand Medicaid independently from the ACA, similar to the proposal in Texas. After the state’s program went into effect, Arkansas saw the sharpest drop in uninsured residents in the nation.

Texas Republican gubernatorial candidate Greg Abbott’s proposed health-care plan does not include plans to expand Medicaid, while Democratic candidate Wendy Davis has endorsed expanding Medicaid.

GOP leaders in Georgia and North Carolina have also refused to expand Medicaid. As a result, Atlanta and Charlotte are among the seven cities with the highest rates of uninsured people.

Georgia state lawmakers passed legislation earlier this year both rejecting Medicaid expansion and prohibiting legislators from advocating for the expansion. In 2012, North Carolina Gov. Pat McCrory (R) said the state would reject Medicaid expansion, and in 2013 McCrory signed legislation preventing its implementation in the state.

In addition to the rejection of Medicaid expansion, North Carolina Republican lawmakers have passed legislation to restrict voting rights and access to welfare benefits, all of which, taken together, sparked the protest movement known as Moral Mondays. The protests have spread to other states, including Georgia and Florida.