For one it is the best of times. For the other, it is the same as it ever was. The difference, a red state without Medicaid Expansion and a blue state with Medicaid Expansion.
I lived in Chicago for a couple years and remember the battles to fund Cook County Hospital. I've lived in the Atlanta area and north Georgia much of my life and am very familiar with Grady Hospital and its vital role in providing care for the indigent in the metro area and trauma care for people from everywhere in the state. Life flights are common from rural areas.
A news article in the Global Post did an excellent review on the fate of both hospitals, which fates have diverged greatly since the passage of the ACA and the adoption of Medicaid expansion in Illinois and the stubborn refusal of Georgia's governor and legislature to expand Medicaid.
http://www.globalpost.com/...
The Global Post Article details how Cook County Hospital has shown a profit for the first time in the 180 years of existence. Imagine that, in less than two years since Obamacare became more or less fully effective, Medicaid expansion allowed a major public hospital to show its first profit. Uninsured patients at Cook County decreased by nearly two-thirds. Cook County went from a $67.6 million loss in fiscal year 2013 to a profit in fiscal year 2014.
And how did Grady Hospital in Atlanta fare without Medicaid Expansion? An increase of almost $130 million of bad debt as there was no change in the uncompensated care at the hospital. The taxpayers of Atlanta and Georgia pick up the tab for this uncompensated care. The hospitals and nursing home administrators in Georgia begged the Governor to expand Medicaid to save them. In addition to the continuing shortfalls at Grady, smaller rural hospitals have closed down:
http://www.georgiahealthnews.com/...
Others have dropped care units that they can no longer afford to keep open:
http://www.georgiahealthnews.com/...
So long as Medicaid Expansion is denied, Georgia patients, the inner city poor and the perennially underserved rural populations, will continue to be denied access to health care. In addition, these losses of local care facilities, underserved populations with long ignored health care issues create a further hidden tax on Georgia residents in these areas, mostly southwest Georgia, as health care premiums for those who are covered by insurance are almost double the premiums of the wealthy suburbs around Atlanta.
http://www.georgiahealthnews.com/...
Another effect of the failure to expand Medicaid and the continued larger than necessary number of uninsured people was that most Georgia counties saw 10% or more increases in premiums. The Atlanta area was mostly stable in comparison to outlying counties based on the figures in the tables from this study by the Kaiser Family Foundation:
http://kff.org/...
The bottom line isn't really financial though, it is the stark contrast between blue state governments that choose to provide help for the poorest and most vulnerable of their residents and red states that choose to wage war on their residents. In the red states, political extremism wins and people will die because of it. The estimate for the annual number of deaths because Georgia did not expand Medicaid coverage is between 561 and 1167 deaths (thanks to Jon Perr and his excellent well researched diary):
http://www.dailykos.com/...
Ultimately, it matters who is elected, from President on down to a city council member. Democrats aren't always as good as they should be and they need to be even better than that when it comes to protecting the interests of the poor, minorities, the elderly and children. But it matters if you elect Republicans. It will kill people for sure. In this cycle's Democratic primaries, I support Bernie Sanders but you better believe I will support Hillary Clinton if she is the party's nominee. I will support any Democrat for any office and never say there is no difference between a Democrat and a Republican. I live in a state dominated by Republicans, in the reddest Congressional district. I know better.