Leave Health Care to the States?

There are a lot of problems with the idea of just leaving health reform up to the states to handle on a case-by-case basis, but Alec MacGillis captures perhaps the most morally serious of them—the states with tons of uninsured people are precisely the states where the political culture doesn’t care about poor people or those who lack insurance. Southern states, in particular, tend to have high uninsurance rates precisely because those are the states that haven’t already enacted measures to expand access to insurance.

This is an instance of the general phenomenon whereby poor people vote for Democratic candidates who spend money on social services for poor people, but poor states tend to elect Republican candidates who prefer low taxes and stingy public services:

figure11 1

Medicaid allows for significant state-to-state variation in generosity and coverage levels. In liberal states, it tends to be very generous. But in conservative states, it tends to be very stingy. Any state-level insurance efforts will recapitulate that pattern. If you want to help poor people in Texas and South Carolina and Arizona get insurance, you have to do it on the federal level.