One of the strangest things about the Patient Protection and Affordable Care Act (PPACA) is watching a law that — whatever its many faults in design and implementation — incorporates many middle-of-the-road concepts that divide America.
I used to get press releases from chambers of commerce in states like Georgia (!) about how great private health insurance purchasing cooperatives (exchanges) would be for businesses, and, in some cases, how great government-run health insurance purchasing cooperatives (public exchanges) would be for individuals.
Some Republicans were at least open to the idea of creating new restrictions or, maybe, a “public reinsurance program” (translation: a subsidy tax so complicated that no ordinary voters would notice that it was a tax) to help health insurers reduce use of medical underwriting.
Even in the health insurance industry itself, who except for very hard-headed actuaries is thrilled about broad use of medical underwriting in health care finance? Who wants to tell a 25-year-old with leukemia, “You used your $2,000 per month income to pay for food and rent instead of insurance. No chemo for you!”?
Now, the Commonwealth Fund has come out with survey results that illustrate some of the ways PPACA is dividing the country. Many states with Republican governors have refused to take PPACA Medicaid expansion money.
Defenders of the expansion program argue that offering Medicaid access to low-income, childless adults is the right thing to do, and that it may reduce and rationalize overall health care costs, by reducing uninsured adults’ reliance on charity care, emergency room care, and care for severe health problems created or exacerbated by lack of access to ordinary preventive and urgent care.
Critics say PPACA drafters used funny federal money to fund expansion, and that, however nice Medicaid expansion might be, the money will soon run out, leaving states to deal with unrealistic expectations, and, possibly, higher health care services costs created by the sudden inflow, and sudden outflow, of funny money.
Time will tell a good story about all of that in a few years.
Right now, Commonwealth Fund figures are telling a story about uninsurance rates in Red States and Blue States.
Before the first PPACA World open enrollment period started, 28 percent of the residents in the Blue states and other states that expanded Medicaid were uninsured, and 38 percent of the residents of Red, non-expansion states were uninsured.
Today, the percentage of “expansion state” adult residents who are uninsured has dropped to 17 percent, and the share of non-expansion state adult residents who are uninsured has crawled a little lower, to 36 percent.