If every state had expanded their Medicaid programs under Obamacare, more than three million people would now have health insurance, according to a large set of data from Enroll America and Civis Analytics analyzed in the New York Times.
That’s how Obamacare was originally intended to work — but in 2012, the Supreme Court ruled the law’s Medicaid expansion to be optional, giving GOP-led states an opening to resist implementing the law. If those states hadn’t gotten the option to refuse this particular provision of the health law, the national uninsurance rate would be two percentage points lower, the new analysis predicts.
That would have dramatically changed the country, and provided an even clearer illustration of Obamacare’s effect on the uninsured (the darker purple indicates a higher rate of uninsured residents):
This data is derived from a national model mapping how the law has affected uninsured individuals across the country. Last week, the New York Times analyzed those numbers to determine that, as a whole, health reform has helped make the country more equal by redistributing resources to the low-income people who were previously locked out of the insurance industry.
But, as illustrated by this follow-up investigation, those gains aren’t being felt equally across states. “The uneven Medicaid expansion, largely a result of Republican politicians’ dislike of the program and their concern that their states might get stuck with the costs, has limited the law’s ability to cover poor Americans living in many of the poorest states in the country,” the New York Times concludes.
Previous analyses of the states that have refused to expand Medicaid have found that the people being denied coverage are disproportionately likely to be low-income people of color. The anti-expansion states also had higher uninsurance rates to begin with, and they’re home to people who tend to be poorer and sicker than the residents in other states.
It’s possible that this week’s midterm elections will start reshaping the map above. Depending on the outcome of the governors’ races, six additional states — Florida, Georgia, Kansas, Maine, Wisconsin, and Alaska — may accept Medicaid coverage next year, according to a recent report from consulting firm Avalere Health. “This is a key election for the future of the Medicaid program,” Avalere’s CEO, Dan Mendelson, said in a statement last week.