Showing posts with label Affordable Care Act. Show all posts
Showing posts with label Affordable Care Act. Show all posts

Thursday, June 10, 2021

Medicaid Expansion Update: What is its Impact on Uninsured Rates?

In the early days of this blog, I wrote extensively on how states were rolling out Medicaid expansion under the Affordable Care Act (aka Obamacare or ACA).  The 2012 Supreme Court decision that upheld the ACA made Medicaid expansion optional for the states.  This expansion allows states to raise the income eligibility level from 100% of the federal poverty level to 133%.

The above map shows that 12 states still refuse to expand Medicaid 11 years after the ACA was passed while 31 states have expanded and 8 states have used different methods to expand.  The map below shows where each state stood on expansion in 2012.  

The census bureau has 2018 as the most recent year where estimates of the uninsured are available.  Thus, to assess the impact of Medicaid expansion, I will compare uninsured rates at the state level between 2010 (the year the ACA was passed) and 2018.  The states will be grouped by whether they refused to expand it in 2018 (19 states), implemented expansion by 2018 (26 states), or implemented it with other methods (6 states).

Expanded by 2018



Change in %



























The table above shows the mean uninsured rates for each group of states with respect to Medicaid expansion.  There was a significant decrease in the uninsured in all three groups due to the implementation of other parts of the ACA.  The states that did not expand Medicaid had higher baseline mean or average uninsured rates at 18.6% compared to 14.6% for those that expanded traditionally and 16.0% for those who expanded using modified methods by 2018.  The uninsured rates for 2018 showed a wider gap in uninsured rates between states that did not expand (12.5%) and the other two groups (7.6% and 8.7% respectively). The standard deviation or SD's show less variability in uninsured rates in all three groups by 2018.

These numbers show that the ACA is having an impact on uninsured rates throughout the U.S.  Medicaid expansion increases this effect in states that have implemented it.  There is still a group of uninsured even in states that have implemented expansion.  A much harder number to measure is the number of uninsured individuals in then U.S.  Further steps will be needed to reach universal coverage.

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Thursday, July 27, 2017

Parallels between 2010 and Todays Healthcare Debate

All of the hoopla over the Russia investigation may be providing a needed temporary distraction from Mitch McConnell's efforts to ram through the repeal and possible replacement of the Affordable Care Act (aka ACA or Obamacare).  John McCain's speech on the Senate floor provided some added drama for the vote to simply allow debate on the bill to move forward.  In their zeal to get something passed how much are they thinking about their impact on ordinary folks?

Looking back on the struggles to get the ACA passed in 2009-2010 we see some parallels to today's debate.  The Democrats had a super majority of 60 votes in the Senate but with the threat of a filibuster, could not afford any defections to pass a bill.  No Republicans supported the ACA (including Susan Collins).  One of the largest sticking points back the was the public option.  The two holdouts for passing the law were Senators Ben Nelson and Joe Lieberman.  They opposed the public option.  There were other disagreements over whether abortion and other procedures would be covered.

This time around the Republicans have a bare majority in the Senate and can afford at least one defection from support for the law to prevent it from passing.  Susan Collins and Lisa Murkowski were the lone holdouts on the vote to have a debate on the bill (both voted against the ACA in 2010).  However there are several potential holdouts for the final vote.  One glaring difference between the two situations is this time the GOP is voting on the bill under budget reconciliation which cannot be filibustered.  Seven years ago the Democrats could have voted on the ACA with a public option under reconciliation but chose not to.  

Adding to the drama over the laws passage was sen. Ted Kennedy's brain cancer.  He did not live to see the vote.  His replacement, Martha Coakley lost the special election to former cosmopolitan model republican Scott Brown.  McCain will stay on with brain cancer to avoid the risk of losing his seat before the final vote which is expected soon but it's a race against time just as it is a race against time for us.

Seven years ago the GOP hammered Nancy Pelosi for saying "we have to pass the bill to find out what's in it."  Now few people really know what's in the GOP bill.  Bills always get rewritten and amended right before they come up for a vote.


Last night provided drama and ooohs and aaahs from the Senate Gallery with Sens. Collins, McCain and Murkowski voting no on the last ditch effort to repeal and replace the ACA thus killing the effort at least for now. While Barack Obama and Nancy Pelosi are enjoyng this debacle, Single Payer advocates can learn thins from both instances.  These instances provide insights into how difficult it is to pass meaningful legislation in today's political climate even ones as flawed as these measures are.  Our founding fathers did not want a king but they were equally afraid of rule by the mob.

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As The ACA (Obamacare) Replacement Fails, the ACA and Single Payer are More Popular than Ever

Monday, March 27, 2017

As The ACA (Obamacare) Replacement Fails, the ACA and Single Payer are More Popular than Ever

The past weeks events regarding the proposed ACA (or Obamacare) repeal and replacement must be causing some amusement among Barack Obama and his minions.  The question remains: Where do we go from here?

The Real Clear Politics Average of public opinion polls has shown a steady increase in support for the ACA since the November election.  According to the average 48% of the US public now support the law while 43.8% oppose.  In previous years the law had consistently poor support from the public.  The few of these polls that asked the reason for the poor support of the law (which I have chronicled in previous posts) showed that a significant number of those opposed it because the law was "not liberal enough."  When this number is added to those who support the law, you have a majority of 54%.  This number has been consistent throughout all of the polls that have asked this question.

These polls do not always specify which changes to the ACA would be needed to make it more liberal.  One poll from May 2016 by the Gallup organization (and summarized by Philip Bump in the Washington Post) did ask respondents about their attitudes toward implementing a single payer plan.  The graph above shows that about 55% support single payer with surprisingly 41% of Republicans supporting it.  This number is close to the 54% I found who want a more liberal healthcare law.  I'm going to make a leap of faith that those who want a 'more liberal' healthcare really meant a single payer plan.
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The US and Republicans Want Health Care Law Repealed....?


Santorum: No One Has Ever Died Because They Didn’t Have Health Care |The New Civil Rights Movement

Tuesday, December 20, 2016

US Life Expectancy Decreases and Those Who Want the Affordable Care Act Expanded Increases

This month it has been reported that life expectancy in 2015 in the US has decreased for the first time since 1993.  The decrease was from 78.9 years in 2014 to 78.8 in 2015.  The reasons for this decrease are unclear though the overall death rate increased by 1.2% last year.  The top causes of death had increased rates except for cancer.  Alzheimer's disease showed the largest increase in mortality.  The study's authors caution that this decrease in life expectancy of 0.1 years (which corresponds to a decrease of 37 days) may be a statistical aberration.

Views of the ACA (CBS News Poll)
Dec 2016
Feb 2015
Working well, keep as is
Good things, but changes needed
Needs to be repealed entirely

One statistic that has changed little in the last 6 years is the level of support for the Affordable Care Act (ACA or Obamacare).  The above table shows how views of the ACA have changed over the last year according to a CBS poll conducted this month.  Overall the poll showed that 45% of the public approve of the ACA while 50% do not.  The same respondents were asked what changes to the law were needed.  Only 10% wanted it kept as is (up from 6% last Feb).  The number who wanted changes made to the law increased to 63% from 60% while the number who want it repealed entirely decreased from 32% in 2015 to 25 this month.  The poll did break the numbers down by political party and found that 47% of Republicans wanted changes compared to 78% of Democrats and 61% of independents.  The poll did not specify which changes were needed to the law.

Opinion of ACA (Pew Research)
Nov 30-Dec 5, 2016
Oct 20-25, 2016
Mar 7-11, 2012
Sep 22-Oct 4, 2011
Jan 5-9, 2011
Nov 4-7, 2010
Expand it
Leave it as is
Repeal it
Don’t Know/Refused
Expand + As is

Another poll was published this month showing essentially a 48% to 47% approval/disapproval ratio (essentially a tie) for the ACA published by Pew research.  The poll did ask respondents (n=752) what changes they wanted to see to the ACA.  39% said expand it which is virtually unchanged from October but increased from 2012 and 2011 levels by 5 to 9%.  The number who wanted it left as is increased by 2% from October but decreased from 2011 by 5 to 7%.  The number who want it repealed decreased by 5% from October but stayed within the values from 2012 to 2010.  If one adds the % who want it expanded to those who want it left as is we find a consistent majority across the six year period ranging from 54% this month to 52% in Nov 2010.

It is a matter of interpretation exactly what "expand it" means but other polls have found similar results using wording of the question "Is the ACA not Liberal Enough" or "Approve" as is, found similar majorities when the two categories are added.  The conclusion is that a majority of the US public wants universal health care with a growing percentage wanting a better bill.  Such actions are unlikely in the short term in the Federal Government with Trump in the White House (though he once supported single payer) and the GOP controlling Congress.

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