September 19, 2013

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


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 Pew Research Center.


  1. John McFarling2 years ago

    Since there is no legal federal exchange under the affordable health care bill, where did this default federal exchange pop up. If it is outside the law then isn’t it illegal?

    1. TxinDal2 years ago

      John, what do you mean by no legal federal exchange? The Affordable Care Act provides for subsidies to assist American’s who qualify for it, to help cover the cost of insurance. Exchanges are a mechanism for comparing apples to apples, the coverage of policies available for the public. The Federal government uses the “exchange” or website for insurance companies to market their policies and that same site is the only place you can apply for a Federal subsidy to help pay the cost of your policy. Why in the world would anyone have a problem with mandating that insurance companies having to all provide a minimum set of coverages in all policies, and require them to use a standardized rating system so that the public could actually understand and compare the policies coverage, cost and then make an informed decision on what policy is best for them? The fact that transparency and a common grading system is required, drives lower prices because companies are competing against one another but offering the same or similar coverages in each tier (ie, bronze, silver, gold, platinum). Now an insurance company can not sell you a basic policy disguised as a high end policy, not to mention, basic preventative care is covered at 100% with no deductibles, encouraging the public to regularly see a healthcare professional so they can work with you to stay healthy rather than only see you once you have very sick and requiring expensive care to correct a problem that may have been caught and reversed or prevented earlier? The ACA encourages individual accountability, informed choices and participation in health/wellness.

  2. Cindy2 years ago

    The United States is supposed to be a world power among the nations, yet we have one of the most corrupt healthcare system’s in the world. It’s not working, everyone has their hand digging deeper into the average joe’s pocket. We all need to be watchdogs, monitor and question every medical bill that we encounter. Why are hospitals allowed to get away with charging $20.00 for a Tylenol, or a medical company charging 800% markup on a walking boot when the same exact boot can be bought over the internet? Why are we allowing this to continue? Why aren’t the republicans in Congress going after hospitals and medical companies who are deciding the charges because of their greed?

  3. Al3 years ago

    I lived under an NHS in the UK for two years What a government sets up and runs was rotten. Everything was rationed The only thing that made it better for me and my family was I could get more was by going 300 miles to the military hospital to get comparable treatment to what we got in the states. I’ll never go back or desire to go back. U only get what u pay for. U pay little u get little.

  4. John3 years ago

    The immorality of the insurance companies and their Republican cronies is disgusting. The United States spends more than any other industrialized nation on healthcare and has the worst system. Other countries provide better healthcare to all for far less cost. But they don’t pay hospital administrators multimillion dollar salaries or dividends to people owning share do insurance companies. Profit needs to be removed from the equation, and we need a single payer system. Read the Time magazine article “Bitter Pill.” It should be required reading for all. I think that we need a law that strips our elected officials of their health insurance. Until we have universal healthcare, Congress needs to go without also.

    1. J Sanchez (Hispanic American)3 years ago

      Your statement that America has the worst healthcare system is simplistic in the extreme. Perhaps if your a prolific cherry picker you can say that but just barely. The fact of the matter is that here is America we have the best medical care with the best possible outcomes. Your talking about access and that’s what the ACA is trying to remedy. The problem is trying to chart a course where the system can turn a profit which you are obviously against. Most liberal progressives are but funny thing is that that are hordes of very very rich liberal progressives who used the American system to get to where they are today. Go figure. Perhaps if when they wrote this law and passed it with some input from those that opposed major parts of it of the law it might have been more widely accepted. Unfortunately it was ram rodded through congress and passed in the senate using a parliamentary trick.
      The ends never justify the means in a nation of laws and hence the problem with the law itself.

    2. David3 years ago

      The only thing I hate more than healthcare is brainwashed political pundits who think Republicans and Democrats are so different.

  5. Maxwell4 years 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”…

  6. LA4 years 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.

    1. David3 years ago

      I took advantage of my last company. They gave me insurance and I paid half for my wife. Had it for years. Felt safe. Finally had to go to the hospital emergency room for a day. And viola. The insurance company refused to pay anything claiming it wasn’t covered. So I ended up having to pay out cash anyway. If they are going to refuse to pay out, why should I pay in?

  7. Richard DeSilver4 years 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?

    1. Michael4 years 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.

      1. Brad4 years 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.

        1. Former Insurance Agent4 years 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?

          1. ksk2 years ago

            Uh, no he did not say he was uninsured. Will that calm your rant?

      2. Lloyd3 years ago

        I am 56 retired on a fixed pension of $29,000 per year and I have had to continue to work as self employed/part time to pay for medical which my wife and I need. My previous Blue Cross was canceled ($580/mth. with no deductible) and my new Blue Cross is now $780 per month with a $12, 700. deductible (or $22,060.) yearly before insurance pays anything) I can’t afford to go to the doctor even with this insurance. I will not be even able to afford the yearly deductible. You may ask why I don’t get a cheaper monthly plan; however, this is the cheapest plan available on the MI Health Care Exchange! I get a subsidy but I have to decrease my part time income to remain qualified….. Some retirement! If I earn $1 too much I will have to pay back the entire subsidy.
        Note: I grew up in Ontario, Canada where I lived until I was 22 years old. I had the O.H.I.P. (the provincial plan) which was free of charge with no deductibles, co-pays, or bills ever, and no unreasonable waiting times. I never saw any medical bills until I moved to Michigan. The healthcare is paid through tax dollars and the citizens and businesses are happy and thriving.
        Most people in Michigan I talk to are terribly worried about their ability to afford basic insurance and basic healthcare. They no longer will consider retirement until they reach Medicare eligibility. Most young people will have no pensions and will starve on the little moneys in their 401Ks.
        Don’t get me wrong…. This decline in healthcare access has been going on for years before Obama Care. I had a family member who was denied health insurance due to a “pre-existing condition”; moreover, there were countless cases of insurance companies cancelling policies when someone got sick, their treatment got too expensive, they even denied medical benefits to someone who got hit by lightning while golfing due to the pre-existing metal dental work. The system was long broken before now and some politicians are currently arguing that they should have some of food off our plates too and would be very happy to see us just go away.
        Shame on us all for allowing basic health care in this country to be a perk of the rich or those fortunate enough to temporarily have it.