Obamacare Handed Clean Bill of Health by Gallup
When the six-month enrollment period of the Affordable Care Act’s insurance exchanges came to a close on March 31, not much time or media energy was devoted to dwelling on the fact that the Obama administration’s target of 7 million sign ups had been reached. Overshadowing that victory was ongoing argument that hitting the enrollment target was not a real sign of success; according to critical analyses, more important to the viability of the marketplaces system created by the health care reform was who enrolled. If a majority those who signed up were previously uninsured then Obamacare successfully expanded coverage as President Barack Obama intended.
Shortly after the March 31 deadline passed, data collected by Gallup between early January and late February was released, showing that the percentage of Americans without health insurance had dropped to 15.9 percent in the early months of 2014, down from 17.1 percent in the fourth-quarter of last year. While Gallup noted both the concurrent timing of the Obamacare exchanges’ enrollment period and the decline of the uninsured rate, as well as the numbers of Americans who obtained coverage either through the exchanges or the expansion of Medicaid, the report did not specifically attribute the gains in insurance coverage to the reform. What Jenna Levy did write was that drop in the uninsured rate was “a sign that the Affordable Care Act, commonly referred to as ‘Obamacare,’ appears to be accomplishing its goal of increasing the percentage of Americans with health insurance coverage.”
Gallup has now confirmed that the country’s uninsurance rate is declining as a result of the health care reform. But the insurance rate among adults aged 18 and older is only falling significantly in the states that chose to both expand Medicaid and set up their own online insurance exchanges.
When Obama signed the health care reform into law on March 23, 2010, fourteen state attorneys general filed lawsuits. They claimed that the law’s requirement that every American, who did not qualify for an exemption, purchase health insurance on the ground was unconstitutional, even though it had been central to the GOP’s health-care reform plans for two decades. In response to the legal opposition, Erwin Chemerinsky, the dean of the law school at the University of California at Irvine, told The New York Times: “There is no case law, post 1937, that would support an individual’s right not to buy health care if the government wants to mandate it.” And, indeed, the Supreme Court’s Chief Justice John Roberts sided with Justices Ruth Bader Ginsburg, Sonia Sotomayor, Stephen Breyer and Elena Kagan in deciding that Obamacare was a valid exercise of Congress’s power to tax, meaning the government could require individuals to purchase insurance or face a tax penalty. What the court did rule unconstitutional was the mandated expansion of Medicaid, finding that withdrawing a state’s funds for its entire Medicaid program because it refused to make the expansion would be coercive. Instead, the Medicaid expansion was made optional.
States with Republican-heavy voter bases, Republican legislatures, and Republican governors by and large failed to participate in the optional changes legislated by the Affordable Care Act. As of March 2014, 26 states — plus Washington D.C. — had decided to widen Medicaid eligibility, with nearly every single Southern State and a broad swatch of the Midwest opting out. Plus, 36 states declined to set-up and operate their own insurance exchanges, meaning approximately 70 percent of all states defaulted to federally-facilitated exchanges — a far greater percentage than expected by the administration. Several states approached exchange operation by partnering with the federal government, and those states are typically counted with the 14 states and the District of Columbia, which operate their own marketplaces. Only four states — North Dakota, New Jersey, Ohio, and Arizona — have decided to expand Medicaid while declining to administer a state-based exchange.
Many states are still in the process of debating these two measures; Nebraska’s state government voted last month to not extend Medicaid, while New Hampshire agreed to the Medicaid expansion. Meanwhile, Utah — a conservative state with a Republican governor, Gary Herbert — is still considering expanding Medicaid, albeit with more flexible terms than Obamacare set out. The plan contains a three-year block grant to cover approximately 110,000 low-income residents with private insurance, as well as cost share and work requirements. Gallup postulated that if Utah passes the legislation other more-conservative leaning states could follow, which would further push down the national unemployment rate.
Data collected between January 3 and April 2 for the Gallup-Healthways Well-Being Index reveals a sharp divide in the number of uninsured residents between the states that left changes to their insurance systems to the federal government and those that expanded Medicaid and created their own insurance marketplaces. On average, the insurance rate in the 21 states and the District of Columbia that have implemented both measures fell from 16.1 percent in 2013 to 13.6 percent in the first quarter of the new year — a decline of 2.5 percent. By comparison, in the remaining states that took only one or neither of those actions, the uninsurance rate dropped from 18.7 percent to 17.9 percent, — a decrease of 0.8 percent.
“While a majority of Americans continue to disapprove of the Affordable Care Act, also known as ‘Obamacare,’ the uninsured rate appears to be declining, as the law intended, explained Gallup’s Dan Witters. “In turn, the states (including the District of Columbia) that have implemented two of the law’s core mechanisms — Medicaid expansion and state health insurance exchanges — are realizing a rate of decline that is substantively greater than what is found among the remaining states that have not done so. Consequently, the gap that previously existed between the two groups has now expanded.”
Across the entire United States, the uninsurance rate has steadily declined since reaching a peak at 18.0 percent in the third quarter of 2013, and now stands at 15.6 percent. By comparison, the nonpartisan Congressional Budget Office, has projected the share of legal U.S. residents without health coverage will decrease from 14 percent this year to 8 percent by 2024.
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