The irony is that the states fighting Obamacare arguably would benefit more than those that are embracing it. States friendly to the program already have a much lower percentage of uninsured residents, and they’re healthier than states that are hostile to the law.
Of the 11 states with the highest rates of uninsured adults, led by Texas at 31 percent, seven are fighting Obamacare. By contrast, some of the states with the fewest health-care challenges, such as Vermont, Hawaii and Connecticut, are doing their best to implement the program.
What’s more, states supportive of Obamacare have lower rates of obesity, diabetes and heart disease deaths, as well as higher life expectancy, compared with the places fighting the law.
The geographic divide over Obamacare usually follows the political leanings that dominate in the states. According to the Kaiser Family Foundation, between 50 and 70 percent of Democrats have generally favored the law, while only 10 to 20 percent of Republicans have. As a result, “blue states” generally show enthusiasm for Obamacare — and are doing much to implement it — and “red states” are not.
It’s safe to conclude, then, that politicians aren’t just crusading against Obamacare in conservative states, they’re following public opinion.
Over time, it’s possible that the disparities at the onset of the Affordable Care Act will diminish if the law works well and reluctant states embrace it. After all, Medicare and Medicaid faced early political resistance, but both programs eventually expanded coverage and became less controversial. Every state was immediately part of Medicare, while it took four years for almost every state to join Medicaid; Alaska joined in 1972, and Arizona in 1982.
From 1963, before the passage of the Medicare and Medicaid law, to 1976, the uninsured fell from a high of 33 percent of the population to 11 percent. Obamacare hopes to accomplish a similar feat; the Congressional Budget Office estimates that the law will reduce the uninsured population from 18 percent today to 8 percent in a decade (excluding undocumented immigrants). That is down from the CBO’s projections two years ago, when the nonpartisan office said only 5 percent of the population would be left without coverage.
But meeting even the diminished expectations could be an uphill climb. If people in states resistant to Obamacare find that it isn’t working very well — in part because of local governments’ efforts to obstruct the law — their already-negative views may intensify.
Moreover, in many places, opposition to Obamacare is not based on a substantive concern — that the program will, for example, increase premiums or reduce consumer choice — but on a philosophical objection.
As Texas Gov. Rick Perry (R) said this month, Texas has not expanded Medicaid because Texans believe that most people should not receive government-sponsored insurance, even if they can’t afford coverage on their own.
“We never thought in the state of Texas that you judge success by the number of people that are on public assistance,” Perry said on CNN.
The TV host, former White House adviser Stephanie Cutter, pointed out that if people can’t afford health insurance, they’ll just go to an emergency room.
Perry’s response: Fine with me.
“And you know what?” he said. “The people of the state of Texas have made the decision that that is how they would rather run their health-care system, rather than allow for Washington, D.C.” to do it.
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