'Go' States Thrive Under Affordable Care Act, 'No' States Don't

By Chris Hoenig


Photo by Shutterstock

Given a chance, the Affordable Care Act is succeeding.

That’s the message from a Harvard University researcher who has taken a deep dive into insurance and Medicaid enrollments for the new year under the law, also known as Obamacare. And she has produced a single bar graph that shows just how much it can help.

There are two main parts of the Affordable Care Act used to measure success in Theda Skocpol’s study: Medicaid expansion and insurance exchanges. Under the Affordable Care Act, the federal government offered each state funding to increase the number of low-income Americans eligible for Medicaid, with the feds footing the full bill to start and no less than 90 percent of it permanently. It also called on governors to create their own state-level insurance exchanges, smaller versions of the mistake-prone healthcare.gov site, where residents could compare insurance plans, learn about subsidies to help them pay for premiums and, ultimately, purchase health insurance.

Both of these parts could be turned away by governors, however, which resulted in Skocpol creating five classifications of states: 14 “Full-Go” states, which expanded Medicaid and run their own exchange websites; 7 “Supporter” states, where Medicaid was expanded and the states are cooperating with the federal healthcare.gov exchange instead of running their own; 2 “Exchange Partner” states, which are cooperating with the healthcare.gov exchange but have declined to expand Medicare; 4 “Medicaid Only” states, which have expanded their Medicaid coverage but are not cooperating with any local or federal healthcare exchange; and 23 “Just Say No” states, run mostly by conservative Republican governors, which have refused both the Medicaid expansion and insurance exchanges.

Using data collected by Charles Gaba of acasignups.net (through Jan. 4), Skocpol was able to determine how the states were measuring up so far to the number of enrollees that were projected by the Kaiser Medicaid Commission (for Medicaid expansion) and the Congressional Budget Office (for exchange purchases).

“Full-Go” states are having the most success by far in getting people enrolled in health coverage. These 14 states are already nearly halfway to their projected Medicaid enrollment and more than a third of the way to their private-insurance goals, despite many states’ exchanges having early hiccups similar to healthcare.gov’s. In the states that accepted Medicare expansion but turned the exchanges over to the federal government, the numbers drop to 15 percent Medicaid enrollment and less than 6 percent of the projections for private insurance.

The numbers continue to drop even further for the remaining three categories of states. Medicaid expansion is nearly nonexistent in “Exchange Partner” (2 percent) and “Just Say No” (1.5 percent) states, while the states that took Medicaid money but have avoided all insurance-exchange activity have reached just 3.8 percent of their Medicaid goals and 3.0 percent of their private insurance projections. “Exchange Partner” (6.3 percent) and “Just Say No” (5.6 percent) states fare slightly better with healthcare.gov enrollees.

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