A few months ago, Gallup
released a survey demonstrating that Obamcare is working better—getting more people insured—in states that have embraced the law. That finding is
reinforced by a new survey from the Urban Institute, and it's largely about which states accepted Medicaid expansion.
Compared with the adult population without insurance in September 2013—just before the ACA’s Marketplaces began the first open enrollment period—uninsured adults are more concentrated in Medicaid nonexpansion states and the South and are more likely to be Spanish Speakers, unmarried, and to have less than a high school education. Two out of five are both low-income and live in states that chose not to expand their Medicaid programs.
As reported previously (Kenney et al. 2014), the uninsured are increasingly concentrated in states that have not expanded Medicaid following the Supreme Court’s June 2012 decision to leave the Medicaid expansion choice up to the states (figure 1). In September 2013, 49.7 percent of uninsured adults lived in states that have not expanded Medicaid. This share increased to 60.6 percent as of June 2014. Very few states in the South have opted to expand Medicaid. Consistent with the increased concentration of remaining uninsured adults in nonexpansion states, the share of uninsured adults living in the South has increased. As of June 2014, 48.9 percent of the remaining uninsured lived in the South, up from 41.5 percent in September 2013.
The differences in the states are becoming more stark, and not just in the individuals who remain uninsured, but in the ongoing cost to states that have refused the expansion and where hospitals are still having to provide uncompensated care. That means
some hospitals are closing, mostly in rural areas—hurting
everyone in these communities.
Republican state lawmakers are hurting their people, the healthcare system in their states, and probably themselves, ultimately, because they are on the wrong side of this politically. One industry official, Paul Keckley, a Nashville-based managing director of health care at consultant Navigant, puts it baldly in talking about the federal taxes everyone is paying to expand coverage: "Would a Republican governor leave 100 percent funding for three years [on the table] and say it ended up in New York? […] That kind of stings in the South."
