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This Just In: Uninsured in Red States Getting Shaft From Lawmakers

Ben Sklar/Getty Images

Obamacare impact by states, via Gallup

Gallup polling is offering yet another snapshot of Obamacare’s progress. But this time the picture doesn’t merely tell us how many Americans are getting insurance. It also shows us where they are getting insurance. The image is all too familiar.

For this latest survey report, published on Wednesday morning, Gallup divided the states into two categories. One group consists of states that are fully embracing the Affordable Care Act. They decided to run their own insurance marketplaces, rather than have the federal government do it, and they are participating in the law’s planned expansion of Medicaid, so that all people with incomes below 133 percent of the poverty line qualify. States in this category include California, Kentucky, and New York. 

The other group is states that have not taken both steps. Either they decided not to run their own marketplaces or they are refusing to expand Medicaid or both. States in this category include Florida, Missouri, and Texas—which neither have their own marketplaces nor have expanded Medicaid—as well as Arizona and Michigan—which are expanding Medicaid but are letting the feds run their marketplaces. 

In the former group, which tend to be more liberal, the percentage of uninsured adults had fallen by 2.5 percentage points. In the latter group, which tend to be more conservative, the percentage has declined by just 0.8 percentage points.

As readers of this space know, the Gallup results are very imprecise, enough that nobody should take specific figures too seriously. And these aggregate totals surely mask all sorts of variation among the states. But the overall pattern—a sharp divergence between the two groups of states—is almost certainly real. 

It’s also very tragic. As as you can see plainly in the above graph of Gallup’s results, the states rejecting part or all of Obamacare are the ones with the most uninsured residents. They are, in other words, the states that need the most help. As my colleague Alec MacGillis has noted, a major goal of the Affordable Care Act was to establish a national standard for insurance coverage. Today that goal remains very much out of reach—thanks to the Supreme Court, which gave states more leeway to refuse the Medicaid expansion, and conservative state officials, who have taken advantage of the opportunity.