This is what we fought for in ACA

Via the indispensible Sarah Kliff at Vox, this pre-post map of Kentucky health insurance coverage puts a lump in my throat. This is what we fought for ACA, and what we will eventually achieve when low-income red states eventually embrace the Medicaid expansion.

I’ll never be involved in another presidential campaign as I was with the Obama campaign and the fight for health reform between 2007 and 2012. I knocked on hundreds of doors, made I-don’t-know-how-many-phone-calls in the hope of achieving near-universal coverage. Maps like this make me so glad that I participated in that fight. That map reflects hundreds of thousands of lives changed, in a single small state that went against President Obama, big time, in both 2008 and 2012.

More from Sarah Kliff here.

This speaks for itself.
This speaks for itself.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect,, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

4 thoughts on “This is what we fought for in ACA”

  1. The remaining pockets of uninsurance are correlated with coal mining:

    Why? Even if miners themselves are insured at work, the industry is unhealthy for communities so you’d expect high takeup. A macho culture (the real Medal-of-Honour thing not posturing), or resentment at Obama's "war on coal"?

    If Grimes defeats McConnell in Kentucky in November, maybe the GOP will reconsider its Adullamite opposition to ACA.
    [UPDATE: this is all wrong, see retraction below – J]

    1. I understand your thesis, but the data don't seem to support it. Pike County is the heart of Coal Country according to your map but there are at least 20 counties—most of which produce little or no coal—with higher uninsurance rates today. Other coal counties in SE Kentucky now appear to have the lowest rates of uninsurance in the state (dark blue in the "After ACA" map).

      Geographically, it looks like the ACA has had the biggest impact in the Appalachian region of eastern Kentucky. I'm not sure what that means sociologically, politically or economically but that's been a desperately impoverished region for decades so I can understand why Pollack is so glad.

    2. I'm seeing the opposite. The best uptake was in coal country and of the remaining lower uptake counties most are not in coal country. Working coal miners have insurance and are paid well relatively speaking — not well enough for the job they're doing by a long shot but it's well over a living wage. Unfortunately, the number of coal jobs in Kentucky is at an all-time low. Medicaid expansion has been a welcome relief for them I'm sure.

      1. Apoogies! I read Harold's colour coding the wrong way round. It's uptake, not uninsurance . that is correlated with coal. So common intuition wins, and there is no paradox to explain.

Comments are closed.