September 19, 2013

Most uninsured Americans live in states that won’t run their own Obamacare exchanges

59.4%

Almost six-in-ten uninsured Americans live in states that haven’t set up their own health-insurance exchanges under the Affordable Care Act.

healthInsurance-exchangeNearly 48 million Americans, 15.4% of the total population, lacked health insurance last year, according to a new Census Bureau report. And most of them — 59.4%, to be exact — live in states that have chosen not to set up their own insurance exchanges under the Affordable Care Act, commonly called Obamacare.

The exchanges — online marketplaces where people can compare different insurance plans and buy coverage — are the centerpiece of the law, which remains controversial and not terribly popular three-and-a-half years after its passage. The enrollment period opens on Oct. 1. Under the law, most Americans must either have insurance by the New Year or pay a penalty (though officials have said people who are insured by April 1 won’t be penalized, which effectively extends the deadline to buy coverage to mid-March).

The law envisioned that most states would set up and run their own online exchanges, with federally-run exchanges as a backstop. However, only 16 states and the District of Columbia have done so; seven more are partnering with the federal government to operate their exchanges. In the other 27 states, people without insurance will use federally managed exchanges to shop for coverage.

Those 27 states — many of which have actively opposed the health care law — contain a majority (59.4%) of the nation’s uninsured people; together they account for 54.6% of the nation’s population. Collectively, 16.8% of people in the “federal default” states were without insurance last year, compared with 14% in the states that have organized their own exchanges and 12.8% in the “partnership” states.

That disparity may further complicate the law’s already-complex rollout. Although exchanges (whether state- or federally-run) will be available in every state, a recent Pew Research Center study found that only 44% of people in the “federal default” states said they’d have access to one, versus 59% in the states with state-based health care exchanges or state-federal partnerships. (In at least one default state, Florida, the state government has barred federally funded “navigators” from using its offices for outreach efforts.)

Much as there’s a deep partisan divide among the American public over the healthcare-reform law (Pew Research found that 73% of Democrats and Democratic-leaning independents support it and 85% of Republicans and Republican-leaning independents oppose it), there’s a clear partisan split on implementation. Among the 22 states (plus D.C.) that are running their own exchanges or partnering with the federal government to do so, Democrats control the legislatures of 17 and hold 18 governorships (or mayorship in the case of D.C.). Among the 27 federal-default states, all but two have Republican governors and 23 have GOP-controlled legislatures.

healthInsurance-uninsuredUninsured rates vary widely throughout the country, according to the Census data, from 24.6% in Texas to 4.1% in Massachusetts (which pioneered its own version of healthcare reform with an individual insurance mandate seven years ago).

 

Category: Daily Number

Topics: Health Care

  1. Photo of Drew DeSilver

    is a Senior Writer at the Pew Research Center.

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6 Comments

  1. Maxwell5 months ago

    What Obama and his friends in the Media aren’t telling Americans about his immigration plan now, but just wait until Americans start paying to cover 12 million Mexican citizens with Obamacare and Medicare.

    As soon as Obama gets his immigration policy passed, the ‘illegal immigrants’ will become ‘lawfully residing immigrants’ as defined by the ACA, and if they should choose to claim poverty their coverage will be free.

    That will force them into Medicare programs, the States that have chosen ‘not’ to setup these exchanges will not be responsible for these additional cost, the cost will go to the Federal Government, only states that have taken Obamacare money to setup these exchanges will be forced to absorb the cost of these illegals integrating into the Medicare system.

    You can read the details under “Potential Coverage Impacts under the ACA”

    aspe.hhs.gov/hsp/11/ImmigrantAcc…

    Reply
  2. LA6 months ago

    I find several things comical. People don’t take advantage of what’s in front of them for years. Their company insurance. We have 200 people where were at right now and that is not company wide. We probably only have maybe 50% on insurance. For a family it’s $130.00 per week major medical. Low deductible. People are crazy for not taking advantage of these situations.

    Reply
  3. Richard DeSilver7 months ago

    It figures! Obviously most of the people without health insurance can’t afford it and still won’t buy it through the exchanges. What happens when the government starts to fine these people and where does that money go and what does it support?

    Reply
    1. Michael7 months ago

      People who can’t afford it are subsidized by the expanded medicaid that has been central to the law from the start, yet many critics don’t mention it, and consequently nearly half of Americans aren’t even aware it exists (according to a recent pew study). This has allowed several mostly southern red state governors to opt out of the expansion with impunity, despite there being no benefit in doing so, which is at least partly why the bill appears to be so bad to citizens of those states. They simply aren’t getting the benefits of Bill at all, but rather see a skeleton variant. Sad.

      Reply
      1. Brad7 months ago

        So maybe I am dumb… But if I cannot afford insurance I will be defaulted to the expanded medicare plan? Will there be deductibles? Co-Pays?

        Who pays for that? I dont understand why we as citizens are being forced to pay for insurance when some are going to continue to live off the government teat! If this was going to be a truely affordable act, then there needed to be affordablility built into it. My policy will be almost double if I were to choose the crap that is being floated as the platinum policy.
        I am not sure that what we are gaining is really any better. Most of those people that were uninsured were eligible for state run medical coverage.
        This is just one area that I feel that the govermnet is overstepping its boundries.

        Reply
        1. Former Insurance Agent6 months ago

          “Most of those people that were uninsured were eligible for state run medical coverage.”

          Your words Brad. Now did I understand your chief complaint to be you’re presently uninsured but will be fanny-smacked if you choose the platinum plan? It seems to me you haven’t done your homework. If you go through the federal exchange and enter your income, you’ll find out how much assistance you’ll receive on the premium. If you’ve already done so and found out you earn too much, than why aren’t you insured now? Is it you believe you’re too young and strong, and things like cancer are terrible accidents only happen to others? That’s the kind of mentality that has caused the health care costs in this country to spiral out of control. When an “immortal” meets an “immovable object” and doesn’t have a three-hundred thousand dollar savings account, oh yes, and is uninsured, well guess what happens? Usually bankruptcy after which “Mr. Former Immortal” walks away scot-free leaving the rest of us to foot those unpaid bills in the form of rising costs. So tell me Brad, if this is such a horrible idea, what alternative do you propose?

          I applaud President Obama for his diligence in starting this health care reform. What the “oppositioners” do is tell half-truths and out-right lies. They imply “this is it and we’re all DOOMED I TELL YOU DOOMED!” You know what I say? Hogwash! (I would’ve used stronger words but I didn’t want to offend younger readers.) This is but a beginning. When a significant portion of our elected governments are either replaced or dig their heads from their overpaid seat-users and actually start representing the people, ALL the people, then you’ll see remarkable advances. To date the only thing I’ve been offered is either “Obamacare” or a reverse to the way things were. You remember how things were don’t you? If not allow me to enlighten you.

          Medical insurance companies ruled the health care in this country. Their powerful lobbyists are still at work funding senate and congressional candidates, paying for the initial misleading TV ads, and financing attacks in the court regarding the law that are ongoing. Just for chuckles’ sake, let’s say they win. Once they’re finished popping Champagne bottles, they’ll IMMEDIATELY start raising the premiums on those with serious medical conditions to the point they can no longer afford the coverage. Glory be, they’ll be able to once again pay obscene quarterly bonuses to their executive management, as well as handsome bonuses to their “regulators” for finding reasons to delay or deny needed care. You know who I mean don’t you? Those nice people you have to call to get approval for treatments and will tell you how they’re helping you by disallowing unneeded tests. Today those companies must refund any excessive profits to their policyholders, but that’s one of the many changes Obama implemented. That’ll also go bye-bye. So what do you say Brad? Should we realize this is just the beginning, or should we demand a return to the old ways?

          Reply