The States That Thwarted Obamacare Have Left Poor People In The Dark About The Law


State policies designed to thwart the implementation of the Affordable Care Act have translated into fewer people getting connected with health care, suggests a new study from Harvard University researchers. Specifically, in the states where lawmakers have worked to undermine the law, poor residents are more likely to be unaware about how they could benefit from Obamacare.

The study, published this week in the Health Affairs journal, examined three red states with historically high rates of uninsurance: Kentucky, Arkansas, and Texas. Lawmakers in those states have all taken varying approaches to Obamacare implementation.

Kentucky is one of the only Southern states that wholeheartedly embraced the law. Lawmakers there agreed to expand Medicaid, created a successful state marketplace, and supported volunteer outreach efforts to teach people about how to enroll in coverage. Arkansas, meanwhile, agreed to compromise on a nontraditional Medicaid expansion and a joint federal-state marketplace, while enacting some limits on outreach efforts. Texas took the most stringent approach, refusing to expand Medicaid or set up a state marketplace while passing tough restrictions on Obamacare volunteers.

According to the Harvard researchers, those state policy decisions “appeared to have had major impacts on enrollment experiences among low-income adults.” Application and enrollment rates — as well as reports of general satisfaction with the enrollment process — were highest in Kentucky, lower in Arkansas, and lowest in Texas. And in each state, at least half of low-income residents had heard nothing about the law’s coverage expansion.


The study found that low-income Americans’ success in signing up for Obamacare had a lot to do with whether they had adequate help navigating the enrollment process, which was plagued with technological glitches when Obamacare’s marketplaces first launched. The participants who received enrollment assistance from so-called “navigators,” the volunteers tasked with helping uninsured people sign up for new plans, were nearly 10 percentage points more likely to successfully get connected with coverage under the law.

But not every state has provided that assistance. Over the past several years, placing restrictions on navigators has emerged as one of the most popular state-level tactics to undermine Obamacare. In at least 17 states across the country, GOP lawmakers have enacted legislative barriers that make it harder for navigators to do their jobs. When these state laws first started emerging in 2013, consumer advocates warned they would translate into fewer people receiving the proper education about the brand-new health care reform law — ultimately suppressing enrollment among the population that could benefit from Obamacare the most.

Two years later, the new study provides some evidence that this situation is unfolding exactly as predicted.

“Navigators and application assistance programs appear to be a valuable approach to improving the effectiveness of the coverage expansion, and states enacting restrictions on these programs are likely harming their low-income residents’ ability to obtain coverage,” the Harvard researchers conclude.

“It’s definitely been an uphill battle,” Mimi Garcia, the Texas director for Enroll America, a group aligned with the White House that has focused on helping Americans sign up for Obamacare, told Kaiser Health News this week. She pointed out that, even if navigators are able to get around the state-imposed restrictions that stifle their volunteer efforts, they still have to contend with misconceptions about the law stemming from the state lawmakers who bash Obamacare.


Anti-Obamacare politicians have rarely been candid about the fact that, on a practical level, their opposition to the law translates into fewer people getting access to health care. But, when it comes to state-level restrictions on education and enrollment campaigns, there certainly appears to be a correlation. Previous studies have found that patients are less likely to get accurate information about Obamacare in states where the governor opposes the law.

“The prospect that millions of Americans will soon gain affordable health coverage is so threatening to Obamacare opponents that they are now persisting in unprecedented obstruction of the law,” Ron Pollack, the president of Families USA, an organization that supports the Affordable Care Act, told the Washington Post back in 2013. And that effort has been pretty successful.