The Upshot at the New York Times has a terrific set of graphs and charts on the Affordable Care Act that explains something important: In the real world, the Patient Protection and Affordable Care Act is more or less doing what it was supposed to do. About 10 million more people have insurance now than a year ago (and this doesn't count young people newly added to their parents' insurance).
The takeaway is just how big a deal Medicaid expansion is — and what the consequences are of delaying it, thanks to the Supreme Court decision giving states the ability to opt out and the willingness of some Republican governors to do so. This is seen most easily in a map of which counties have the most uninsured now, and the relatively low levels of uninsured in (expansion-accepting) Kentucky right between higher levels in (expansion-rejecting) Indiana and Tennessee.
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Generally, the states with the highest remaining levels of uninsured are in the South (minus Kentucky and Arkansas), some are in the Republican northern Rocky Mountain states and in Maine, sticking out like a sore thumb. Presumably, a sore thumb without the coverage for a doctor's visit.
The other takeaway of the piece is the extent to which PPACA is a tool to fight inequality.
The data shows that the law has done something rather unusual in the American economy this century: It has pushed back against inequality, essentially redistributing income — in the form of health insurance or insurance subsidies — to many of the groups that have fared poorly over the last few decades.
Remember "spread the wealth around"? That's exactly what's happening. Rural areas are benefiting more than urban ones, poor neighborhoods more than wealthy ones.
No, this isn't the first entrance of the federal government into health insurance. The old and the poor were already subsidized. So were people with jobs in big companies and those in unions — because the federal government has been subsidizing job-based health insurance for decades. In some ways, the health-care law just evens the playing field in the short run.
A good debate about PPACA would discuss whether transferring wealth (and, more than anything, transferring risk) in this way is a good idea. Or maybe that debate isn't needed. Given Republicans' reluctance in a number of states to stop Medicaid expansion where it has already happened, it's possible their polls (and their political instincts) say that most people support some government-backed universal health insurance.
This is pretty much how I read the surveys indicating that people hate PPACA but like most individual pieces of it. If that's the case, what we need most from the administration's critics are ideas for improving how the law is being carried out and specific ways to make it better — not outdated and empty calls for repeal.
To contact the writer of this article: Jonathan Bernstein at [email protected].
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