When states take the initiative

Ezra Klein’s Wonkblog posted an interesting article this morning and sent it out as part of their morning email blast.  The article touched on something I had little information about as you don’t hear it in regards to the PPACA.

It seems that the US is on track to end up with a dual track medical system where coverage differs depending on the state.  States where Republicans are in control have opted out of the PPACA for the most part.  They have not set up insurance exchanges on their own, have not opted to expand Medicaid in most cases, and have generally been hands off or outright obstructive in the rollout of the PPACA.  On the other hand, states under control of the Democratic Party have embraced all that is the PPACA and have gone to great lengths to try to ensure its success.

The crux of the Wonkblog article titled “Wonkbook:  One nation, two health-care systems”:

The state-by-state nature of the exchanges creates a potential problem even after the technical problems are fixed: Since each state exchange is its own risk pool, the states where sign-up is difficult and delayed may end up with fewer healthy people and more sick people then the states where sign-up worked from the beginning. That would mean, in year two, higher premiums for insurance in the exchanges, and more difficulties for the law. The problems will be particularly bad in states that aren’t attempting to advertise or otherwise sign young and healthy people up for their exchanges.

The result could be that many blue states see cover both a successful Medicaid expansion and successful exchanges while many red states both reject the Medicaid expansion and see their exchange fail.

When looking at the difference between the states that chose to expand Medicaid vs the states that did not, the political leanings of the states is easy to see.

*courtesy of Wonkblog

*courtesy of Wonkblog

As for the states controlled by Republicans, you can see that there is not much effort to assist any part of the PPACA, including the insurance exchanges where insurance will be purchased by its citizens.

*courtesy of Wonkblog

*courtesy of Wonkblog

Looking at how this is playing out struck one of those memory cells in my brain that made me scratch my head.  The GOP is always campaigning on the creeping federal government taking over things where the states should be in control.  Here is the perfect opportunity for the states to control their destiny, and what does the conservative states do???  They basically leave everything to Uncle Sam to do the job for them.  On the other hand, the Democratic states have apparently embraced states’ rights and did what they had to in order to cover their citizens.

We keep hearing about how nobody’s signed up for the PPACA, but those reports only tell half the facts as they’re only referring to the people who have enrolled through the federal exchanges.  Those would typically be the conservative controlled states that refused to do the work to ensure their people are covered.  The one exception is Kentucky, where the Democratic governor basically took control away from the GOP controlled legislature to ensure that his citizens would be covered.

A tally of states who have registered citizens in their own exchanges include but not limited to;

  • Oregon
  • Washington
  • New York
  • Kentucky

It’s easy to claim that the PPACA is a failure when you look at the federal exchange because that system was set to fail.  However, when you look at the individual state success, it appears that there are many who were looking for that coverage and are taking full advantage of gaining access to health insurance.  Only time will tell how this works out, but if Congress doesn’t work together to fix this legislation, we’re going to end up with an insurance system of have’s and have-not’s that is based on where you live as opposed to how much you earn.




2 thoughts on “When states take the initiative

  1. Is this PPACA thingie and the exchanges gonna work?
    I dunno.
    I do know that the opposition has stated this will be a colossal failure, and they will do anything to impede it’s potential.
    Predicting that failure is one thing, but it is quite another to actively secure that failure by not participating in the process.
    Self fulfilled prophesy.
    If it doesn’t work out, we just get another opportunity to reinstate the public option.


    • I think it would work if people made it work. Seems like the proof is beginning to show that. I think that the opposition to this will ultimately lead to single payer and not just the public option. If the PPACA fails, I think it will take the current insurance system down with it as collateral damage.

      Just my opinion though.


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