FacebookTwitterGoogle+RedditEmail

ObamaCare is Only “Exploding” in the Red States

When he talks about his efforts to repeal the Affordable Care ActPresident Trumpalmost always asserts that Obamacare is “exploding.” Republican members of Congress make similar claims, insisting that Obamacare is unsustainable—and that they therefore have no choice but to “repeal and replace” it.

There is some basis for this argument. More than 1,300 counties only have one insurer in their exchanges, meaning there is no competition. But there is a nuance that Republicans willfully ignore: This is a problem of their own creation that is largely confined to red states.

Where Republican governors have sought to sabotage the program, they have largely succeeded. Where Democratic governors have tried to make the ACA work, they too have largely succeeded.

Here are the basic numbers. In states with Republican governors, more than 40 million people live in counties with only one insurer. In states with Democratic governors, there are 10.7 million people who live in such counties.

The difference is far more dramatic if we exclude North Carolina from the Democratic list. While North Carolina does now have a Democratic governor, it had a Republican governor until January, and even now the Legislature is overwhelmingly Republican.

Not counting North Carolina, only 2.1 million people in Democratic states live in counties without competition. Put another way, if someone lives in a state with a Democratic governor other than North Carolina, they have a 1.8% probability of only having a single insurer in their exchange. If they live in a state with a Republican governor, there is a 20.7% probability of the same.

There are two main ways in which Republican governors have been effective in sabotaging Obamacare in their states. The first and most important was by refusing to expand Medicaid.

Governors who chose to expand that program pulled many lower-income people out of the Obamacare insurance pool — people who tend to be less healthy and have higher medical bills on average. By taking this higher-cost population out of the exchanges, they reduced the risk to insurers. Applying this logic inversely, governors who refused to expand Medicaid ended up with a less-healthy mix of people in the exchanges.

The other issue is the extent to which states took the initiative to promote Obamacare. Less healthy people generally don’t have to be prodded to buy insurance, since they know they need it. The issue is whether more healthy people buy into the system. Insurers are going to lose money if all the people they insure have serious health problems.

Democratic governors generally tried to persuade people to buy insurance, while Republican governors were more often neutral, if not openly hostile, to the program. As a result, fewer healthy people bought into the exchanges in their states, making the system less profitable for insurers.

In addition, Republican governors and Republican insurance commissioners were often less cooperative with insurance companies. While Democratic governors cajoled insurers to enter and stay in the exchanges, and met reasonable regulatory concerns, Republican governors had little interest in making their exchanges work.

Now we see Trump and the rest of the GOP boasting about their sabotage. Because Republicans have been so successful in keeping many of their residents from getting insurance, they think the country should trust them to overhaul the ACA.

Sorry folks, it doesn’t work that way.

This column originally appeared in the Los Angeles Times.

More articles by:

Dean Baker is the senior economist at the Center for Economic and Policy Research in Washington, DC. 

Weekend Edition
January 18, 2019
Friday - Sunday
Melvin Goodman
Star Wars Revisited: One More Nightmare From Trump
John Davis
“Weather Terrorism:” a National Emergency
Jeffrey St. Clair
Roaming Charges: Sometimes an Establishment Hack is Just What You Need
Joshua Frank
Montana Public Schools Block Pro-LGBTQ Websites
Louisa Willcox
Sky Bears, Earth Bears: Finding and Losing True North
Robert Fisk
Bernie Sanders, Israel and the Middle East
Robert Fantina
Pompeo, the U.S. and Iran
David Rosen
The Biden Band-Aid: Will Democrats Contain the Insurgency?
Nick Pemberton
Human Trafficking Should Be Illegal
Steve Early - Suzanne Gordon
Did Donald Get The Memo? Trump’s VA Secretary Denounces ‘Veteran as Victim’ Stereotyping
Andrew Levine
The Tulsi Gabbard Factor
John W. Whitehead
The Danger Within: Border Patrol is Turning America into a Constitution-Free Zone
Dana E. Abizaid
Kafka’s Grave: a Pilgrimage in Prague
Rebecca Lee
Punishment Through Humiliation: Justice For Sexual Assault Survivors
Dahr Jamail
A Planet in Crisis: The Heat’s On Us
John Feffer
Trump Punts on Syria: The Forever War is Far From Over
Dave Lindorff
Shut Down the War Machine!
Glenn Sacks
LA Teachers’ Strike: Student Voices of the Los Angeles Education Revolt  
Mark Ashwill
The Metamorphosis of International Students Into Honorary US Nationalists: a View from Viet Nam
Ramzy Baroud
The Moral Travesty of Israel Seeking Arab, Iranian Money for its Alleged Nakba
Ron Jacobs
Allen Ginsberg Takes a Trip
Jake Johnston
Haiti by the Numbers
Binoy Kampmark
No-Confidence Survivor: Theresa May and Brexit
Victor Grossman
Red Flowers for Rosa and Karl
Cesar Chelala
President Donald Trump’s “Magical Realism”
Christopher Brauchli
An Education in Fraud
Paul Bentley
The Death Penalty for Canada’s Foreign Policy?
David Swanson
Top 10 Reasons Not to Love NATO
Louis Proyect
Breaking the Left’s Gay Taboo
Kani Xulam
A Saudi Teen and Freedom’s Shining Moment
Ralph Nader
Bar Barr or Regret this Dictatorial Attorney General
Jessicah Pierre
A Dream Deferred: MLK’s Dream of Economic Justice is Far From Reality
Edward J. Martin
Glossip v. Gross, the Eighth Amendment and the Torture Court of the United States
Chuck Collins
Shutdown Expands the Ranks of the “Underwater Nation”
Paul Edwards
War Whores
Peter Crowley
Outsourcing Still Affects Us: This and AI Worker Displacement Need Not be Inevitable
Alycee Lane
Trump’s Federal Government Shutdown and Unpaid Dishwashers
Martha Rosenberg
New Questions About Ritual Slaughter as Belgium Bans the Practice
Nicky Reid
Panarchy as Full Spectrum Intersectionality
Jill Richardson
Hollywood’s Fat Shaming is Getting Old
Nyla Ali Khan
A Woman’s Wide Sphere of Influence Within Folklore and Social Practices
Richard Klin
Dial Israel: Amos Oz, 1939-2018
David Rovics
Of Triggers and Bullets
David Yearsley
Bass on Top: the Genius of Paul Chambers
Elliot Sperber
Eddie Spaghetti’s Alphabet
FacebookTwitterGoogle+RedditEmail