Showing posts with label Single Payer. Show all posts
Showing posts with label Single Payer. 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

2010

2018

Change in %

N

M

SD

M

SD

none

19

18.6%

4.2%

12.5%

3.0%

6.1%

yes

26

14.6%

4.5%

7.6%

2.5%

7.0%

modified

6

16.0%

3.3%

8.7%

2.4%

7.4%


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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Saturday, March 7, 2020

Lessons from Super Tuesday: Health Care in the Deep South

The Democratic Presidential race has changed radically since the South Carolina Primary.  As a Bernie Sanders supporter I was so hopeful for him to have a strong showing.  The outcome was very sobering.  I thought I would take a look at the exit poll data from SC and other states from Super Tuesday on the issue of Sanders' Medicare for All (M4A) proposal.

SC
Support
Oppose
AL
Support
Oppose
VA
Support
Oppose
49%
46%
51%
43%
52%
45%
Biden
44%
55%
Biden
50%
76%
Biden
42%
67%
Sanders
29%
12%
Sanders
27%
5%
Sanders
33%
12%
TN
Support
Oppose
NC
Support
Oppose
TX
Support
Oppose
53%
43%
55%
41%
64%
33%
Biden
32%
51%
Biden
34%
54%
Biden
25%
46%
Sanders
38%
9%
Sanders
36%
12%
Sanders
39%
13%

South Carolina and the five southern Super Tuesday states are summarized in the above tables.  The numbers right below "Support" and "Oppose" are the percentage of primary voters who either support or oppose the statement "How do you feel about replacing all private health insurance with a single government plan for everyone?"  

In South Carolina, it was favored by 49% to 46%.  Biden beat Sanders 44% to 29% of those who support M4A.  Biden beat Sanders 55% to 12% among those who oppose M4A.  Similar patterns were found in Alabama and Virginia.  In Tennessee, North Carolina, and Texas, Sanders did slightly better than Biden among those who support M4A and was trounced by Biden among those who did not.  Texas had the strongest support for Sanders proposal but he only bested Biden by 14 points among those who do.

It is also known that older African American voters overwhelmingly supported Biden.  The exit poll does not state whether they were more or less likely to support Medicare for All.  

MA
Support
Oppose
CA
Support
Oppose
VT
Support
Oppose
50%
45%

55%
36%

73%
23%
Biden
23%
46%
Biden
14%
35%
Biden
14%
42%
Sanders
41%
13%
Sanders
48%
14%
Sanders
62%
25%
Warren
27%
14%


Three of the states outside of the deep south where Sanders fared better against Biden are shown above: Massachusetts, California, and Vermont.  In Massachusetts the 69% who supported M4A favored Sanders over Biden by 41% to 23%.  Warren received 27% among those who do.

In California and Vermont, Sanders had strong support among those who support M4A.  Biden won among those who did not.  The lesson from these primaries and the 2016 and 2008 elections is that it is almost impossible to win the Democratic party nomination for president without substantial African American support.  It would be interesting to look at what role support for M4A plays in this.

**Update**

Biden has now won Mississippi, Michigan, and Missouri.  In Mississippi 60% of voters support M4A but 75% of those voted for Biden.  In the video below, Biden said he would veto any M4A bill that came to his desk as president.  In Missouri and Michigan those supported M4A preferred Sanders.



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Deep South Primaries