Obamacare Even Works in Red States If You Let It

Two of the states that have had the most success with Obamacare are two states that have been among the most active in the Congressional efforts to repeal it: Kentucky and Arkansas.

The Affordable Care Act’s main goal, besides lowering the cost of healthcare, is to insure the uninsured. So if you measure Obamacare’s success by that singular goal, the Bluegrass State and the Natural State are actually the leading states in the nation, according to a Gallup analysis.

In Arkansas, 22.5 percent of residents did not have health insurance in 2013. Last year, that number nearly halved to just 11.4 percent. The 11.1-point drop was tops in the country.

Kentucky was the only other state to pull off a double-digit percentage point drop, falling from 20.4 percent uninsured in 2013 to just 9.8 percent in 2014 (a 10.6-point decrease).

But seeing either of these states at the top of the new-signup rolls is a bit of a surprise.

Obamacare isn’t exactly popular in either state, largely thanks to the rhetoric of the state’s representatives in Washington. Each have two Republican senators, though the Senate has been far quieter in opposition over the past few years.

The House, on the other hand, has voted at least 60 different times to repeal or defund the Affordable Care Act (or at least key portions of it). Their vote last month gave freshman Republicans the opportunity to go on the record with their opposition, officially logging a vote against Obamacare.

Two of those freshmen just so happen to represent Arkansas, which hasn’t had a Democrat in the House since 2013. All four of the state’s delegates voted to repeal.

Kentucky provided an additional five votes toward repeal, although it also had the lone dissenter from either state, Democratic Congressman John Yarmuth.

So how do two states that have collectively cast 300-plus congressional votes against Obamacare lead the nation in effective implementation

A little sleight of hand. Some trickery.

Both had Democratic governors when it came time to implement the law. Arkansas Governor Mike Beebe—who was replaced this year by Republican Asa Hutchinson—quietly negotiated a deal with Republican state lawmakers to accept expanded Medicaid funding from the federal government, with the condition that the money be used to purchase private coverage for low-income residents.

The deal was agreed to by legislators and the Obama administration, and the state soon began offering the “private option,” which sounds a lot better to conservative, anti-Obamacare residents than “expanded government-funded option.”

In Kentucky, the plan was even simpler. Governor Steve Beshear had officials set up the state insurance-exchange marketplace, but gave it a simple name: Kynect. The exchange wasn’t marketed as the state’s Obamacare exchange, it was just Kynect.

The result: Residents bought insurance through Kynect thinking it had nothing to do with Obamacare.

Take this exchange at a 2013 job fair, witnessed by Jason Cherkis of The Huffington Post and retold by President Obama:

A middle-aged man in a red golf shirt shuffles up to a small folding table with gold trim, in a booth adorned with a flotilla of helium balloons, where government workers at the Kentucky State Fair are hawking the virtues of Kynect, the state’s health benefit exchange established by Obamacare

The man is impressed. “This beats Obamacare, I hope,” he mutters to one of the workers.

“Do I burst his bubble” wonders Reina Diaz-Dempsey, overseeing the operation. She doesn’t.

Does this mean Obamacare is working everywhere, including every traditionally conservative state Not if the state doesn’t allow it to work.

The 10 states with the highest rates of uninsured are North Carolina, Georgia, Florida, Mississippi, Louisiana, Texas, Oklahoma, Arizona, Montana and Alaska.

All are red states. Not a single one accepted expanded Medicare funding. Not a single one opened a state-run exchange.

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