WASHINGTON — Here’s a reality check for President Barack Obama’s health overhaul: Three out of four uninsured Americans live in states that have yet to figure out how to deliver on its promise of affordable medical care.
This is the year that will make or break the health care law. States were supposed to be partners in carrying out the biggest safety net expansion since Medicare and Medicaid, and the White House claims they’re making steady progress.
But an analysis by The Associated Press shows that states are moving in fits and starts. Combined with new insurance coverage estimates from the nonpartisan Urban Institute, it reveals a patchwork nation.
Such uneven progress could have real consequences.
If it continues, it will mean disparities and delays from state to state in carrying out an immense expansion of health insurance scheduled in the law for 2014. That could happen even if the Supreme Court upholds Obama’s law, called the Patient Protection and Affordable Care Act.
“There will be something there, but if it doesn’t mesh with the state’s culture and if the state is not really supporting it, that certainly won’t help it succeed,” said Urban Institute senior researcher Matthew Buettgens.
The 13 states that have adopted a plan are home to only 1 in 4 of the uninsured. An additional 17 states are making headway, but it’s not clear all will succeed. The 20 states lagging behind account for the biggest share of the uninsured, 42 percent.
Among the lagging states are four with arguably the most to gain. Texas, Florida, Georgia and Ohio together would add more than 7 million people to the insurance rolls, according to Urban Institute estimates, reducing the annual burden of charity care by $10.7 billion.
“It’s not that we want something for free, but we want something we can afford,” said Vicki McCuistion of Driftwood, Texas, who works two part-time jobs and is uninsured. With the nation’s highest uninsured rate, her state has made little progress.
The Obama administration says McCuistion and others in the same predicament have nothing to fear. “The fact of states moving at different rates does not create disparities for a particular state’s uninsured population,” said Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the federal Department of Health and Human Services.
That’s because the law says that if a state isn’t ready, the federal government will step in. Larsen insists the government will be ready, but it’s not as easy as handing out insurance cards.
Someone has to set up health insurance exchanges, new one-stop supermarkets with online and landline capabilities for those who buy coverage individually.
A secure infrastructure must be created to verify income, legal residency and other personal information, and smooth enrollment in private insurance plans or Medicaid. Many middle-class households will be eligible for tax credits to help pay premiums for private coverage. Separate exchanges must be created for small businesses.
“It’s a very heavy lift,” said California’s health secretary, Diana Dooley, whose state was one of the first to approve a plan. “Coverage is certainly important, but it’s not the only part. It is very complex.”
California has nearly 7.5 million residents without coverage, more than half of the 12.7 million uninsured in the states with a plan. An estimated 2.9 million Californians would gain coverage, according to the Urban Institute’s research, funded by the nonpartisan Robert Wood Johnson Foundation.
Democrats who wrote the overhaul law had hoped that most states would be willing partners, putting aside partisan differences to build the exchanges and help cover more than 30 million uninsured nationally. It’s not turning out that way.
Some states, mainly those led by Democrats, are far along. Others, usually led by Republicans, have done little. Separately, about half the states are suing to overturn the law.
Time is running out for states, which must have their plans ready for a federal approval deadline of Jan. 1, 2013. Those not ready risk triggering the default requirement that Washington run their exchange.
Yet in states where Republican repudiation of the health care law has blocked exchanges, there’s little incentive to advance before the Supreme Court rules. A decision is expected this summer, and many state legislatures aren’t scheduled to meet past late spring.
The result if the law is upheld could be greater federal sway over health care in the states, the very outcome conservatives say they want to prevent.
“If you give states the opportunity to decide their own destiny, and some choose to ignore it for partisan reasons, they almost make the case against themselves for more federal intervention,” said Sen. Ben Nelson, D-Neb.
A conservative, Nelson was on the winning side of a heated argument among Democrats over who should run exchanges, the feds or the states. Liberals lost their demand for a federal exchange, insulated from state politics.
“It’s pretty hard to take care of the states when they don’t take care of themselves,” said Nelson, who regrets that the concession he fought for has been dismissed by so many states.
The AP’s analysis divided states into four broad groups: those that have adopted a plan for exchanges, those that made substantial progress, those where the outlook is unclear, and those with no significant progress. AP statehouse reporters were consulted in cases of conflicting information.
Thirteen states, plus the District of Columbia, have adopted a plan.
By contrast, in 20 states either the outlook is unclear or there has been no significant progress. Those states include more than 21 million of the 50 million uninsured Americans.
Four have made no significant progress. They are Arkansas, Florida, Louisiana and New Hampshire. The last three returned planning money to the federal government. In Arkansas, Democratic Gov. Mike Beebe ran into immovable GOP opposition in the Legislature. Beebe acknowledges that the federal government will have to run the exchange, but is exploring a fallback option.
In the other 16 states, the outlook is unclear because of failure to advance legislation or paralyzing political disputes that often pit Republicans fervently trying to stop what they deride as “Obamacare” against fellow Republicans who are more pragmatic.
In Kansas, for example, Insurance Commissioner Sandy Praeger is pushing hard for a state exchange, but Gov. Sam Brownback returned a $31 million federal grant, saying the state would not act before the Supreme Court rules. Both officials are Republicans.
“It’s just presidential politics,” said Praeger, discussing the situation nationally. “It’s less about whether exchanges make sense and more about trying to repeal the whole law.” As a result, outlook is unclear for a state with 361,000 uninsured residents.
There is a bright spot for Obama and backers of the law.
An additional 17 states have made substantial progress, although that’s no guarantee of success. Last week in Wisconsin, GOP Gov. Scott Walker abruptly halted planning and announced he will return $38 million in federal money.
AP defined states making substantial progress as ones where governors or legislatures have made a significant commitment to set up exchanges. Another important factor was state acceptance of a federal exchange establishment grant.
That group accounts for just under one-third of the uninsured, about 16 million people.
It includes populous states such as New York, Illinois, North Carolina and New Jersey, which combined would add more than 3 million people to the insurance rolls.
Several are led by Republican governors, including Virginia and Indiana, which have declared their intent to establish insurance exchanges under certain conditions. Other states that have advanced under Republican governors include Arizona and New Mexico.
For uninsured people living in states that have done little, the situation is demoralizing.
Gov. Rick Perry’s opposition to the law scuttled plans to advance an exchange bill in the Texas Legislature last year, when Perry was contemplating his presidential run. The Legislature doesn’t meet this year, so the situation is unclear.
McCuistion and her husband, Dan, are among the nearly 6.7 million Texans who lack coverage. Dan is self-employed as the owner of a specialty tree service. Vicki works part time for two nonprofit organizations. The McCuistions have been uninsured throughout their 17-year marriage, although their three daughters now have coverage through the Children’s Health Insurance Program. Dan McCuistion has been nursing a bad back for years, and it only seems to get worse.
“For me it almost feels like a ticking time bomb,” his wife said.
Dan McCuistion says he doesn’t believe Americans have a constitutional right to health care, but he would take advantage of affordable coverage if it was offered to him. He’s exasperated with Perry and other Texas politicians. “They give a lot of rhetoric toward families, but their actions don’t meet up with what they are saying,” he said.
Perry’s office says it’s principle, not lack of compassion.
“Gov. Perry believes ‘Obamacare’ is unconstitutional, misguided and unsustainable, and Texas, along with other states, is taking legal action to end this massive government overreach,” said spokeswoman Lucy Nashed. “There are no plans to implement an exchange.”
How long is it going to take to actually understand what has to be implamented ? This perfume covered pig wasnt even gone over in Congress They had to pass it to find out what was in it Brilliant plan Nancy.
The information is out there for you to read up on. It has been for almost two years now. IF you want to understand the Affordable Care Act in a final implemented version, read up on Massachusetts. They have been living with it for years and they have far more of their people covered than we do.
The law was debated in congress, extensively. In fact, this law had more debate time than almost any law in history.
The law is not any more complex than any other piece of significant legislation. You speak as if the terms were not disclosed before the votes. That is a very incredible lie. Congresspersons have aids that review policy in detail. Further, this was worked to death in committee for almost a year. You really don’t believe that congress lacks the sophistication to fully review the laws they pass, do you? You couldn’t be that out of touch.
There are so many howlers in this piece, it’s difficut to pick just one.
For instance:
“funded by the nonpartisan Robert Wood Johnson Foundation.”
Yeah, they’re “nonpartisan.” So what if they work hand in glove with George Soros’s Open Society Institute and are notoriously left-wing. Oh, and they got a waiver from Obamacare. Surely the fact that Obama health care czar Nancy-Ann DeParle sits on the foundation’s board of trustees has nothing to do with this.
Labor unions, big Obama supporters, received waivers representing 543,812 workers since June 17, 2011. By contrast, private employers with a total of 69,813 employees, many of whom work for small businesses, received waivers.
Senator Ben Nelson? He of the Cornhusker Kickback? He played “conservative” Democrat, holding back his vote for Obamacare until he was promised that federal taxpayers would pick up, in perpetuity, Nebraska’s Medicaid costs, in addition to special regulatory exemptions for Nebraska insurance companies like Mutual of Omaha. The deal was so odious that even Harry Reid got rid of it.
And Nebraskans were so opposed to Nelson’s support that he saw the handwriting on the wall and announced he won’t be running for re-election rather than face certain defeat at the polls.
Here’s hoping that the Supreme Court puts a stake through the heart of this abomination.
What a sad, one-sided explanation. The waivers that were approved are not permanent. They expire in 2014 and were granted to allow time for those that offer “mini-med” plans time to bump up their coverage and not face penalties. We’re talking about companies like McDonald’s, Ruby Tuesday, Jack-in-the-Box and small businesses that employ few employees at low salaries.
As for labor unions, those 543,812 come from the Service Employee International Union, which has over 2.1 million members. We’re talking about maids, janitors, security officers, nursing home caretakers, child care providers and other union members who are on the low end of wages and are offered minimum insurance plans. We are not talking about unions with “cadillac plans” whose coverage excedes the standards set by the Affordable Healthcare Act. The unions, like businesses, are given a set time to comply, not evade the limits, altogether.
Nelson’s decision to step aside is more a frustration with his fellow Democrats for laying their wrath on him for his lack of support for the bill. He grew tired of being a target from all sides and decided to retire. If the popular Bob Kerrey decides to enter the race, it’s likely it will be a Democrat replacing him.
Here’s hoping the Supreme Court upholds the provisions in this bill.
One of the biggest problems we face in this country is exemplified by your comment. A thorough review of a law was conducted by very knowledgeable people who do this for a living. Instead of debating the issue like adults, on the merits, it is reduced to attacks on the sources and their credibility.
If we cannot trust organizations like the RWJ foundation to assess healthcare policy, we will not be able to ever accomplish anything as a country again.
If you really beieve that the president abused his power to treat unions preferentially, shy has he not been impeached? If what you allege were true, there are a few hundred powerful insiders that could start impeachment proceedings today. The reason there have not been is because what you allege did not occur in the way you claim.
Think. What in the heck will it take to make you ditto-heads just think through an argument yourselves for once?
“Instead of debating the issue like adults, on the merits, it is reduced to attacks on the sources and their credibility.”
Pointing out that RWJ Foundation is a decidedly left-wing organization, not “non-partisan” as described, is hardly an attack. I know the left likes to characterize any disagreement with their comrades as such, but in the real world it just doesn’t work this way.
“If you really beieve that the president abused his power to treat unions preferentially, shy has he not been impeached? ”
Perhaps because the lawsuit against the implementation of Obamacare is scheduled to be heard by the Supreme Court, in which case the preferential treatment would become a moot point if decided in favor of freedom.
Any idea why the Democrats, many of whom were screeching their heads off for years about President Bush’s “illegal” war in Iraq, never initiated impeachment proceedings against him?
Think.
Implementation of the law is what is before the supreme court, not influence peddling. You are accusing the president of influence peddling without any real case made.
If what you are suggesting is true, that would be impeachable and completely outside the scope of the supreme courts action. They generally review very specific and narrow arguments and decide accordingly.
The president clearly has almost complete authority to conduct military actions. There was never a strong case for impeachment made about war powers violations. If you recall, the part where discretion was questioned ended up with a Scooter Libby conviction.
First, they try to abort you; then, they tax you to death; then they want to euthanize you. Liberals, don’t they just kill ‘ya?
Euthanize? Do you refer to doctor assisted suicide? Oregon has it, know who is using it? Educated people who do research into whatever condition they have contracted and have decided they do not choose to suffer. Biology requires us to die, it take someone with the ethics and morality of a coffee stain to require people suffer before they die. Oh and if you don’t like the idea of doctor assisted suicide, support stem cell research so we can have a shot at curing these people of these deadly cancers, diseases, etc. But oh wait, Republicans don’t like that either, at least until they become sick and they run off to Europe where they don’t have to follow policies that they themselves handed down.
I hope this dream comes to fruition someday and I can actually buy healthcare someday that is less than 50% of my income. I can’t afford to pay 80% of my income for health insurance so I have to stay on the bankruptcy plan and hope that I stay healthy. It is demoralizing to have a governor that doesn’t care about health care for the working poor.
There are millions of others who work hard and have no insurance. The no holds barred effort to malign this law is for one clear and obvious reason: once it comes into full effect, it will become so popular nobody will be able to imagine life without it.
In Canada, they passed a healthcare for all act and the one who wrote the law is the most revered Canadian in their history.
The principles behind this law, when looking at the facts not the smears, are unobjectionable to anyone who isn’t looking to get rich raping the sick. That would be a very large majority. Sadly, most of the country has been mislead by the corporatized media that refuses to deal with this in a factual way.
America is broken. If it doesn’t get its head out of its propagandized butt, it will be broke and irrelevant as well. We can either become the greatest turn around story or become a full fledged third world nation withing a decade. The choice is ours. I choose progress so my support is behind Obama. A vote for the GOP, except Ron Paul, is a vote for plutocracy and ultimately, fascism. When one small group controls too much wealth, there is not other way to keep order. That, and nothing less, is the magnitude of the challenge before us.
Hey Ricardo, it is called healthcare, not Obamacare. Welcome to America!
Well, duh. This problem has been brewing for a long time. With millions uninsured, obivously this isn’t going to be as simple as snapping your fingers, but we can’t keep kicking the problem down the road.
Has anybody else heard how the IRS has had to hire 12,000 additional employees to deal with all the Obamacare crap on the horizon because of all the disability and various other tax-related claims associated with it that will be upcoming? Yeah that should be awesome, 12,000 more IRS workers….. We need Obama to be the next Jimmy Carter and go away.
Both Carter and Obama have Nobel Prizes, what did George W. ever get? A certificate of Appreciation from Haliburton?
The IRS reported that individuals and companies underpaid $385 billion in taxes last year after audits and other enforcement efforts. They also investigated 226,000 cases of identity fraud. Congress’s response was to cut $300 million from their budget this year, making it even harder to catch fraud in the system.
That claim of 12,000 new agents was a made up number by foes of the healthcare plan based on assumptions and fear mongering. Two years have passed since that claim was made and the IRS has only seen employee reductions in their workforce. Once again, myth has failed to match reality, which is par for the course with the anti-Obama crowd.
(Duplicate post but I found the newer related article first)
Kudos to the states that are working on their plans. Brickbats (and worse) to those states that aren’t. As for the states that are both working on their health plans but joining in the SCOTUS suit against ACA, quite duplicitous but at least they’re working on it. That goes for Maine too. Covering all bets? Just being ornery? Only LePage et al. know for sure.