This weird-looking Medicaid expansion map would sadden Dr. King on his holiday

(This column is cross-posted at the Huffington Post.)

I wonder what Dr. King would think about the current health reform debate. OK I don’t really wonder. Here, for example, are his comments, apparently made here in Chicago:

Of all the forms of inequality, injustice in health care is the most shocking and inhumane.

Martin Luther King supported health care as a human right. He also knew how far we had to go as a nation in making that right a reality.

King was the energizing force behind the Southern Christian Leadership Conference (SCLC). I suspect he would be ashamed but unsurprised to see his home region so resistant to the basic expansion of health insurance coverage to Americans with incomes below the poverty line. To some extent, the extent of southern resistance is obscured by maps such as the one below, that display which states have rejected the Medicaid expansio­­­n around the country:

Screen Shot 2015-01-19 at 3.13.50 PMMany of the shaded states such as Wyoming and Montana are huge but sparsely populated. Others such as Wisconsin have small populations left uncovered for other reasons.

Harvard post-doctoral researcher Laura Yasaitis is an expert at drawing different kinds of maps. At my request, she made me a map in which the size of every state was proportional to the number of people who landed in the “Medicaid gap.” (She couldn’t quite do that, since states such as California and New York would simply vanish. We drew each of these states as if they had shut out 2,000 state residents instead of zero. She also taught me how to make Cartograms. SO you may see more such items in this space.)

When we did all that, here’s what the US map would like if it were scaled by the number of affected people in each state (see below): Continue reading “This weird-looking Medicaid expansion map would sadden Dr. King on his holiday”

ACA redistribution via Medicaid: what it means for future reform

The self imposed redistribution from mostly poor (mostly red) states, to mostly rich (mostly blue) states via the ACA Medicaid expansion is a direct result of the June 2012 Supreme Court ruling that made it voluntary.

That 7-2 court decision, and the subsequent state decisions, mean that the primary liberal/progressive health reform goal of expanding insurance coverage is being thwarted in some of the most needy states. Liberals/progressives have two choices: fight out the state-by-state Medicaid expansion decisions, or seek a health reform deal with conservatives that would be more likely to expand coverage in the non-expanding, poorest states, sooner. The first is not a pleasing outcome, and the second seems like a political impossibility. Continue reading “ACA redistribution via Medicaid: what it means for future reform”

ACA: self imposed redistribution from poor to rich states

At present, 24 States (and DC) have decided to move ahead with the Medicaid expansion provided for in Obamacare, and 21 have rejected expansion, while 6 are still considering their options. If the current decisions hold, it will result in a self-imposed redistribution of money from poorer (and typically Red states), to richer (and typically Blue ones).

According to an analysis I have done using Kaiser Family Foundation data–in 2016 alone–the 24 expanding states will receive $30.3 Billion additional federal dollars, while those not expanding will forego an additional $35.0 Billion they could have had (the fence sitters have an aggregate $15.2 Billion at stake in 2016). This represents a huge redistribution of federal money from non-expanding to expanding states. The table below highlights the biggest self imposed losers, and winners, again for 2016 alone (there are predictable impacts on state uninsured rates).

ScreenHunter_04 Oct. 25 14.45

Note: total is for all states in foregoing & gaining group.

Continue reading “ACA: self imposed redistribution from poor to rich states”