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Sunday marks 100 days until millions of Americans can start signing up for subsidized health insurance for the first time in their lives.

The whole point of the Affordable Care Act is to expand health insurance. But here’s the thing, even after the law has taken effect, about 30 million people -- almost all of them U.S. citizens -- still won’t be covered.

Dr. Steffie Woolhandler, who co-authored a recent report about the uninsured under the new health care law in the Health Affairs blog, explains who will be out of luck.

“The majority are white. 80 percent are citizens. The majority are employed,” she says. Woolhandler notes most of the 30 million people would get federal money to help pay for insurance. But, she says, with salaries averaging $22,000 for most of them, that won’t be enough.

“Even if you are subsidized, you still have to pay thousands of dollars out of pocket and lots of low and middle income people won’t be able to do that,” she says. Woolhandler says many of these people work in industries that don’t offer insurance, such as agriculture, forestry, and the service sector. She says between premiums, co-pays and deductibles, health costs will easily run into the thousands.

“That would be hard,” says Russ, a New York-based musician who says he already has trouble paying his medical bills.

Russ has a bad heart. He says because he only brings in $30,000 a year, some months he skips his blood thinners, other months it’s the cholesterol pills.

“When you have very few alternatives, you tend to take the choice you have to take. The best of a lousy bunch,” he says.

For people like Russ, less insurance means less care. According to the Urban Institute, the uninsured get about half the care they would get if they had insurance.

What does that mean for the rest of us?

“Strictly economically, having 10 percent uninsured means that healthcare spending will be lower,” says economist Paul Ginsburg, who runs the Center for Studying Health System Change.

And most economists agree lowering healthcare costs is good for the nation’s economy. But, it might not be that simple.

“We usually want to save money through delivering care more efficiently. Not by having people who need care go without,” says Ginsburg. Ginsburg adds while 30 million uninsured people will save money, there will be costs, sicker patients.

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Follow Dan Gorenstein at @dmgorenstein