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What's the matter with Arkansas (and Idaho, and Oklahoma, and….)

Harold Pollack is the Helen Ross Professor of Social Service Administration at the University of Chicago and a Special Correspondent for The Treatment.

The New Deal was famously described as an arrangement whereby the South was forced against its will to accept billions of dollars every year. Something similar might be said of the current health reform. Washington is on pins and needles waiting to discern the votes of Blue Dog Representatives whose constituents have the most to gain from health reform. 

I was reminded of this fact by Michael Tomasky's recent column. He draws attention to a nice Urban Institute report by Genevieve Kinney and colleagues. Urban's report examines insurance coverage across congressional districts. Looking over the results, Tomasky notes that Representatives who are waffling or pledging to vote against this bill not only undermine President Obama, they also hurt tens of thousands of their own uninsured constituents. Consider Mike Ross, who represents the Arkansas's 4th. Census data indicate that more than 100,000 of his constituents are uninsured. The same is true of Henry Cuellar, Jim Matheson, Dan Boren, Mike McIntyre, and several others.

There is another irony, noted by NPRs Peter Overby. Fifty-three of the hundred congressional districts with the highest uninsurance rates are represented "either by Republican lawmakers who are fighting the overhaul, or by conservative Blue Dog Democrats who have slowed down and diluted the overhaul proposals." In many Blue-Dog districts, one in five working-age adults has no health insurance coverage.

Check out this NPR interactive U.S. map. It shows vast regions of Red-State America with very high numbers of the uninsured: Georgia, Arkansas, Louisiana, Texas, coastal North and South Carolina, the Mississippi delta, southern Missouri, much of Oklahoma and Idaho, parts of Kentucky and West Virginia, and more. Millions of others in the same areas would benefit from affordability credits and from consumer protections provided by an insurance exchange. Some wavering Democrats represent hardscrabble blue-collar districts in Ohio, Pennsylvania, and the Midwest. Many of their constituents require affordability credits and other protections embodied in the current bill.

The contrast with Blue-state America is both stark and inescapable. Massachusetts, New Jersey, New York, Pennsylvania, Connecticut, northern California, Wisconsin, Minnesota, and Illinois have much higher rates of health insurance coverage. No wonder Scott Brown found such a ready audience.

Right now, health reform is a heavy lift in many districts. Constituents don't know what these measures actually would do. Hard times breed political discontent, and many people harbor cultural, religious, and generational ambivalence towards President Obama himself that infect the politics of health reform. 

Once again, Americans who have the most to gain from activist government are often the very people most distrustful of such measures. In the short-run, these perceptions may cause problems come November and even come 2012. In the long-run, I believe this is an opportunity. Once health reform embeds itself within the fabric of American life, I'm betting that millions of Red-State Americans will not wish to see it go.