Skip to main content

Map of U.S. with data points on insured rates included.

Some of the nation's largest cities could reduce their uninsured population by more than half if their state lawmakers would relent and accept Medicaid expansion funding under Obamacare. That's the conclusion of a new study from the Urban Institute and Robert Wood Johnson Foundation.

The study looked at 14 diverse, large cities, seven of which are in states that are expanding. The number of uninsured people in those cities should drop by an average of 57 percent. In the non-expansion states, that decline will average 30 percent. Detroit, in expansion state Michigan, will see a 66 percent drop while Atlanta, will see just a 25 percent reduction. That speaks to the significance of the "woodwork" effect—people who discover they're eligible for Medicaid through the application process for insurance and through stepped-up outreach efforts. But those cities are missing out.

The cities that are really being hurt: Memphis, Miami, and Philadelphia where more than half of the population in each would be eligible for Medicaid after expansion. The pain goes beyond the people left uninsured, the report concludes, and has larger social and economic ramifications as well.

Cities in states not expanding Medicaid would face other challenges in addition to having more uninsured residents and foregoing additional revenue. There will be reductions in Medicare reimbursement and Medicare and Medicaid disproportionate share hospital payments under the ACA, which could be particularly difficult for urban safety-net providers serving uninsured people across a wider region. Also, many states require counties to maintain indigent care programs or pay part of the costs of Medicaid.

Differences in the impact of the ACA on cities also reflect a wide diversity in income, immigration status, and race and ethnicity. For example, nearly two-thirds of the uninsured in Detroit have incomes below 138 percent of the federal poverty level, compared with only 38 percent in Phoenix. Nearly 80 percent of the uninsured in Miami are Hispanic, while more than three-quarters of the uninsured in Detroit are non-Hispanic blacks.

Not coincidentally, those are the populations that Democrats need to get to the polls in 2014. Here's a very good issue to help make that happen.

Originally posted to Joan McCarter on Mon Jun 23, 2014 at 09:03 AM PDT.

Also republished by Daily Kos.

Your Email has been sent.
You must add at least one tag to this diary before publishing it.

Add keywords that describe this diary. Separate multiple keywords with commas.
Tagging tips - Search For Tags - Browse For Tags


More Tagging tips:

A tag is a way to search for this diary. If someone is searching for "Barack Obama," is this a diary they'd be trying to find?

Use a person's full name, without any title. Senator Obama may become President Obama, and Michelle Obama might run for office.

If your diary covers an election or elected official, use election tags, which are generally the state abbreviation followed by the office. CA-01 is the first district House seat. CA-Sen covers both senate races. NY-GOV covers the New York governor's race.

Tags do not compound: that is, "education reform" is a completely different tag from "education". A tag like "reform" alone is probably not meaningful.

Consider if one or more of these tags fits your diary: Civil Rights, Community, Congress, Culture, Economy, Education, Elections, Energy, Environment, Health Care, International, Labor, Law, Media, Meta, National Security, Science, Transportation, or White House. If your diary is specific to a state, consider adding the state (California, Texas, etc). Keep in mind, though, that there are many wonderful and important diaries that don't fit in any of these tags. Don't worry if yours doesn't.

You can add a private note to this diary when hotlisting it:
Are you sure you want to remove this diary from your hotlist?
Are you sure you want to remove your recommendation? You can only recommend a diary once, so you will not be able to re-recommend it afterwards.
Rescue this diary, and add a note:
Are you sure you want to remove this diary from Rescue?
Choose where to republish this diary. The diary will be added to the queue for that group. Publish it from the queue to make it appear.

You must be a member of a group to use this feature.

Add a quick update to your diary without changing the diary itself:
Are you sure you want to remove this diary?
(The diary will be removed from the site and returned to your drafts for further editing.)
(The diary will be removed.)
Are you sure you want to save these changes to the published diary?

Comment Preferences

Subscribe or Donate to support Daily Kos.

Click here for the mobile view of the site