“This year it’s more of a state-specific story,”

November 1, 2015 7:12 PM

We Mapped the Uninsured. You'll Notice a Pattern. By Quoctrung Bui and Margot Sanger-Katz [The New York Times]

Two years into the health care law, clear regional patterns are emerging about who has health insurance in America and who still doesn’t. The remaining uninsured are primarily in the South and the Southwest. They tend to be poor. They tend to live in Republican-leaning states. The rates of people without insurance in the Northeast and the upper Midwest have fallen into the single digits since the Affordable Care Act’s main provisions kicked in. But in many parts of the country, obtaining health insurance is still a problem for many Americans.

For a detailed discussion of the methods used to make these calculations, read our article from last year on this model.

posted by Fizz (32 comments total)

I agree with the sentiment but these chloropleth maps seem to be constructed with quantiles to accentuate very small differences in health insurance rates. And splitting it by county is inherently a terrible idea, since the vast majority of Americans live in a small percentage of counties. The key line that "red and blue states have seen similar declines among the uninsured since 2013" is hidden in the small text on a scatterplot. I do support the ACA, but this article is very sloppy and fails to make a very strong case that it's done anything in the last 2 years.
posted by miyabo at 7:38 PM on November 1, 2015 [6 favorites]

I disagree. Most states didnt have more than 20 percent uninsured so small differences do make a difference in the number of uninsured. One of the reason for using counties is that each county has their own offices distributing medicaid benefits.

I see the changes a lot and insurance does help people with access to care . It has worked extremely well. Marginalized communities are able to get health care and it creates an enviroments where people can overcome illnesses and be people.
posted by AlexiaSky at 7:50 PM on November 1, 2015 [9 favorites]

The key line that "red and blue states have seen similar declines among the uninsured since 2013" is hidden in the small text on a scatterplot. I do support the ACA, but this article is very sloppy and fails to make a very strong case that it's done anything in the last 2 years.

Well, what is the only common policy that's been implemented since 2014? The uninsured rate doesn't just magically drop on it's own, something changed, which was clearly the ACA. That's obvious enough that it doesn't need "proven", it's not like Blue states were doing something else to expand healthcare access while Republican controlled states in the South were clueless as to how it was happening. The article is mapping the results of policy choices made on a state level, which is worth showing where a drop from 16% to 9% represents several million people nationally, but regionally concentrated. Not groundbreaking or anything, because this is exactly what every serious article for the last two years has found, but it's still worth pointing out where Republican leaders are deliberately harming their own constituents, and people like maps.
posted by T.D. Strange at 8:13 PM on November 1, 2015 [12 favorites]

What's up with Arizona, Nevada and Montana?

I was surprised the article doesn't really talk about why the uninsured rate went up when the chloropleth scale highlights it so much.
posted by pmv at 8:30 PM on November 1, 2015 [3 favorites]

Montana is only getting the Medicare expansion as of 2016.

"Montana's Medicaid expansion is coming later than it would have if not for a mishap two years ago. In 2013, Montana state Rep. Tom Jacobson (D) accidentally cast the deciding vote against a Medicaid expansion bill he supported, and state House Republicans declined to allow a re-vote on the measure."
posted by CheeseDigestsAll at 9:31 PM on November 1, 2015 [9 favorites]

It seems like the overall story is things got a lot better in many bluer places and only got a little better in many redder places. But, why are there so many counties and several states where the percentage of uninsured shot up and got much, much worse? Look at Alaska and Arizona. And counties in Florida and elsewhere. Things didn't get better more slowly there, they got a ,lot worse. Is it because the federal money that used to support some program in those counties and states is now diverted to ACA stuff? Or is it a different sad story in every instance?
posted by Cassford at 10:06 PM on November 1, 2015

the correct team is: statistician, reporter, and cartographer - not graphic designer.
posted by j_curiouser at 10:19 PM on November 1, 2015 [4 favorites]

The NYT used similar maps to show: Who Would Have Health Insurance if Medicaid Expansion Weren't Optional.

An additional three million low-income Americans would receive health insurance had the Supreme Court not ruled that states could opt out of the Medicaid expansion.
posted by Davenhill at 11:53 PM on November 1, 2015 [5 favorites]

If you don't make enough money to qualify for a subsidy, and your State opted out of the Medicaid expansion, there's no way you can afford insurance. The Republican States with high uninsured rates opted out.
posted by mightshould at 12:25 AM on November 2, 2015 [3 favorites]

Well, it's only ancedotal evidence, but the mandate part of the ACA caused more than a few people I know to go out and cancel their individual insurance.

Because if Obama said they had to have it, then fuck him they were getting rid of it.
posted by sideshow at 12:40 AM on November 2, 2015 [4 favorites]

Cassford:

Some of the changes between last year’s map and this one may reflect refinements of the Enroll model more than major shifts in the level of the uninsured. In a few states, Enroll’s 2014 estimates differed from the 2014 census by more than a few percentage points. The states with these errors were those that had large rural, Hispanic or Native American populations: Alaska, New Mexico, Texas and Arizona, for example. On this year’s map, it looks as if New Mexico’s uninsured rate has rebounded, but that might just be a correction from an incorrect 2014 estimate.

From the very end of the article.
posted by Justinian at 2:55 AM on November 2, 2015 [2 favorites]

Indiana's "Medicaid expansion" isn't as straightforward as it is in other states. And it's damned hard to find providers who in-network for the states' low-income coverage.
posted by Thorzdad at 5:02 AM on November 2, 2015

I wonder how many are ideologically opposed, and are refusing to be covered by the socialist anti-corporate nanny state Muslim loving black helicopter UN one world government feds?

I mean, come on. Some folks just got scruples.
posted by clvrmnky at 5:17 AM on November 2, 2015

And now, this.
posted by General Malaise at 5:36 AM on November 2, 2015 [2 favorites]

Jesus. I try hard to tell myself that the GOP wants progress on these issues but that they just have a different way of going about it, but I never convince myself. I pretty much literally think these anti-Medicaid expansion folks are evil. There isn't even a sound local fiscal argument for it, because the Federal match for newly eligible (i.e., people covered under expanded Medicaid) is close to 99% right now.
posted by OmieWise at 6:03 AM on November 2, 2015 [4 favorites]

The lack of a federal public option really hurt the effectiveness of the bill.
posted by Drinky Die at 6:07 AM on November 2, 2015 [5 favorites]

How can people continue to vote for politicians who have publicly-funded health insurance for themselves and their families but who want to deprive their constituents of access to basic health insurance?
posted by mareli at 6:47 AM on November 2, 2015 [3 favorites]

It's actually worse than just refusing to expand Medicaid. It turns out that Red states that did not expand Medicaid had a higher increase in the state share of Medicaid spending costs than states that did expand Medicaid. So the Red states are actually spending more money just to make sure poor people don't get health care. That's some real Obamacare and poor people hate there.
posted by JackFlash at 7:33 AM on November 2, 2015 [20 favorites]

I am unemployed. I lost my job in February. I didn't sign up on health care, because guess what fucko. I DON'T HAVE MONEY! But OOOOOOH I have to sign up or FINES! Finally I figure ok, I'll see if I can. OH, It's over 200 bucks just for the cheapest fucking plans. With 6k deductibles. Of money I don't have.

Turns out I can't even SIGN UP because I was too late to even try to sign up (you have like 30 or 60 days or whatever if you lose your job outside the stupid 2 month registration period).

I got a job, no health care cuz it was temp. So now I'm done with it and I look. Same shit. STILL ridiculous pricing. Absolutely not a free market, and definitely not as socialist program. It's the worst of both worlds. A mandate for exorbitant prices and if you don't make enough yuou get a piddling discount on the monthly fee, but you still have to pay 6k of money you don't fucking have.

Sorry I am absolutely despising Obamacare despite all the claims of its proponents.

So, comparing the prices on the online exchange, I thought perhaps this means I had amazingly cheap health care at my old company. So I asked my roomie what her health care is like and it's on par of the cheapness of my old plan at my old job, so the fucking market plans aren't even comparable to the employer provided bullshit. So - ok, maybe its' cheaper for individual insurance than it used to be but it's still goddamned expensive.

And there are no caps on deductibles, so that whole "OH HEY ITS GREAT IT LIMITS 80% ON PREMIUMS FOR HEALTH CARE SO MORE MONEY GOES TO HEALTH CARE" is a bullshit line to make you thin it's not a money grab. They can just increase deductibles and your'e fucked, there's nothing stopping them from doing that, and that they are (as reported by Kaiser, a non-partisan think-tank).

Sorry I am absolutely furious and bitter that this has neither a real honest to god competitive market that I can choose to buy from at any time nor a real single-payer option.

The best I can hope for is paying the 600 dollar fine (assuming I made what I think I will end up making) and go on walgreens cheap drug plan and hope my drugs are good enough and basically it's just like Obamacare never passed for me except now I'm out 600 (which is still cheaper than 9000 before I see any fucking benefit anyways).

I know - it's fucking anecdote, but please don't just say "well it's just right-wing assholes who are spiting obama" It's not. I'm about as fucking left as they come and this is a piece of shit plan that does nothing to help those of us who are caught in the middle without any other way. No I haven't looked at Badgercare (Wisconsin's Medicare thingy), I don't think I make little enough to be on it, frankly (assuming I even could get on with the current way it is now). And my situation is constantly changing, because hey why have a permanent economy job. We need to abolish employer sponsored health care and make everyone have the same access to all the market at once. If we're going to a market system We need strict rules and limits, but this whole "1 tier of quality for people who are lucky enough to have jobs and fuck y'all else" well that's not cool.

I tried my best to give it the benefit of the doubt, and maybe statistically it's all fucking peaches for the masses. But looking at these prices...

Nominal insurance (I pay my monthly premiums) without actual USE of insurance... Well - what's being measured here? How many people are actually even fucking USING the insurance they have? Yeah I'll pay the fucking premium, then I won't go to the doctor, because It's too expensive, so "I have Insurance" but I really don't. How much of that is going on? I hazard a lot more than the pro-Obama care camp wants to let on.
posted by symbioid at 9:14 AM on November 2, 2015 [4 favorites]

Jesus. I try hard to tell myself that the GOP wants progress on these issues but that they just have a different way of going about it, but I never convince myself. I pretty much literally think these anti-Medicaid expansion folks are evil. There isn't even a sound local fiscal argument for it, because the Federal match for newly eligible (i.e., people covered under expanded Medicaid) is close to 99% right now.

Tribalism, really. "They like it=it must be bad." Also, being a Christian fundamentalist teaches you to suspect things that provide pleasure, make you feel satisfied, make you feel secure, or otherwise don't punish you or someone else. Does it make you or someone else happy? Probably sinful. This makes it easier to cause suffering for yourself and others (especially others) in the name of spiritual purity.

It's pretty fucked up.

But, people aren't always in a position to pull up stakes and relocate, so maybe we need something like a new underground railroad, or a Scarlet Pimpernel, who can go into places like Georgia and Mississippi and rescue people and spirit them away to safety outside the south.

I have a better idea; why don't ya'll migrate down here and vote in local elections?
posted by emjaybee at 9:16 AM on November 2, 2015 [3 favorites]

Sorry I am absolutely despising Obamacare despite all the claims of its proponents... No I haven't looked at Badgercare (Wisconsin's Medicare thingy). I don't think I make little enough to be on it, frankly.

The ACA was supposed to cover people like you under the expanded Medicaid program. Unfortunately, the Supreme Court gave the states permission to opt out of that. It's really not the ACA's fault that Scott Walker refused to expand Medicaid in Wisconsin to cover people with slightly higher incomes.

That said, it sounds like you should probably look into it anyway. It might cover more than you think.
posted by OnceUponATime at 9:37 AM on November 2, 2015 [9 favorites]

Turns out I can't even SIGN UP because I was too late to even try to sign up.

The reason for this rule is to prevent people from gaming the system by not buying insurance until they get sick or changing from a cheap plan to a better plan later. Before Obamacare, insurance companies could simply refuse to cover people who already have pre-existing conditions. After Obamacare, insurance companies must accept all applicants, regardless of their health status. But this means that everyone must have insurance and not just when they need it.

If you lost your job in February, you should have gotten a notice from your employer regarding COBRA and Obamacare deadlines for enrollment. With no income, you should have been eligible for subsidies that would have paid most of the cost of the insurance.

However, there is a catch in Wisconsin. Since Republicans in Wisconsin refused to expand Medicaid, you would have been ineligible for subsidized insurance if your income was too low. That's a problem with Wisconsin politics, not Obamacare.

But note, if you are ineligible for Medicaid in Wisconsin because your income is too low, then you are exempted from all Obamacare penalties for not having insurance. Obamacare will not penalize you for Republican obstinance.
posted by JackFlash at 9:43 AM on November 2, 2015 [20 favorites]

symbioid, this may or may not be helpful for your specific situation, but just fyi: in addition to tax credits to subsidize premiums, Obamacare also offers subsidies for other out-of-pocket costs (copays, deductibles) for people who earn up to 250% of FPL (link)

But I agree with your general point that a deductible of $6,000 is a pretty major financial hardship for almost everyone and it's dismaying that so many of the plans with affordable premiums have them.
posted by Asparagus at 9:46 AM on November 2, 2015 [1 favorite]

I try hard to tell myself that the GOP wants progress on these issues but that they just have a different way of going about it

Why would you think that? They have said over and over again that they don't think that this is a legitimate role for the government.
posted by thelonius at 9:53 AM on November 2, 2015 [5 favorites]

The ACA was supposed to cover people like you under the expanded Medicaid program.

Well, sort of. There's was always going to be a gap even as the law was written between the people who made too much for even expanded medicaid yet too little to qualify for exchange subsidies, which I think is what he's saying is his situation.

A public insurance option would have solved that issue and completed the Rube Goldberg machine without any significant gaps like that to trap people, but, you know, socialism.

It's better than the status quo, but hardly perfect (see years and years of previously on Metafilter if you want to re-litigate the whole thing). Plenty of people are still getting screwed even in blue states with complete implementation, which you can see from the linked map, 6-9% is still millions of people falling through the gaps.
posted by T.D. Strange at 10:12 AM on November 2, 2015 [1 favorite]

The best I can hope for is paying the 600 dollar fine.

For 2015, this year, the maximum penalty is $325 or 2% of income. And this is pro-rated for the number of months uninsured, so if you were uninsured for only 10 months since February, the penalty would be $270. As stated above, you likely would qualify for a penalty exemption if you could not get on Medicaid because your state refused to expand Medicaid.
posted by JackFlash at 10:15 AM on November 2, 2015 [5 favorites]

There's was always going to be a gap even as the law was written between the people who made too much for even expanded medicaid yet too little to qualify for exchange subsidies, which I think is what he's saying is his situation.

This is incorrect. There is no gap for states that expanded Medicaid. If your household income is below 138% of the federal poverty limit, then you get almost free Medicaid. If above 138%, then you get subsidized Obamacare insurance.

The "making too little money" trap only occurs in states that refused the federal Medicaid expansion. Note that the federal government pays 100% of the cost of expansion, which gradually declines to 90% in 2020. So it really is absolutely free money that the Red states are refusing.
posted by JackFlash at 10:21 AM on November 2, 2015 [5 favorites]

And this is exactly what they want, for people like symboid to blame Obamacare for the way the Republicans are screwing with people's lives.
posted by Justinian at 11:15 AM on November 2, 2015 [17 favorites]

Why would you think that? They have said over and over again that they don't think that this is a legitimate role for the government.

Hence my admonition to myself that they have a different way of going about addressing problems like this. I'm not in any doubt about the policies the GOP is against.
posted by OmieWise at 12:17 PM on November 2, 2015

Plenty of people are still getting screwed even in blue states with complete implementation, which you can see from the linked map, 6-9% is still millions of people falling through the gaps.

Looking at Massachusetts, which has effectively had Obamacare and its Romneycare equivalent for almost a decade, the lower limit is likely to be around 5% under current rules. This 5% includes undocumented immigrants ineligible for Obamacare and too many poor people who simply don't get around to accessing the welfare support available to them. There is also a significant number of people who are just between jobs for a month or two in any snapshot census sample.
posted by JackFlash at 1:50 PM on November 2, 2015 [2 favorites]

Whelp, Kentucky just voted by a wide margin to elect Tea Party businessman Matt Bevin over Democratic AG Jack Conway for governor. Bevin vowed to dismantle the highly effective Kynect healthcare exchange defended by incumbent Democrat Steve Beshear, and even to repeal (or at least narrow) the state's Medicaid expansion. Now some 400,000 low-income Kentuckians have their insurance at risk of elimination, and at the hands of a governor-elect who once relied on state grants to rescue his destroyed business that had been too expensive to insure.
posted by Rhaomi at 5:39 PM on November 3, 2015

. for all the Kentuckians who will die thanks to this sadistic asshole.
posted by zombieflanders at 5:27 AM on November 4, 2015