States of Obamacare

It will take years to figure out how well Obamacare works and to improve it, but one thing’s already clear.

In states trying to make it work, it does better.

More people in those states will get affordable insurance. They’ll have regular exams so small health problems will get caught and won’t turn into big ones. People with chronic illnesses will be better monitored. Deaths will be prevented.

But in states that have made it harder for their citizens to get insurance, a lot fewer will get coverage and care.

The Affordable Care Act has provisions that apply throughout the country, like insurance companies being unable to deny coverage for those with pre-existing conditions. But that doesn’t do much good if people don’t know how to buy insurance through the new health insurance exchanges. It doesn’t help if they don’t know they can get financial aid to buy insurance.

Just look at what’s happening in Missouri, a poster story for undermining access to insurance. As the New York Times reports, “state and local officials cannot provide ‘assistance or resources of any kind’ to a federal exchange unless such assistance is specifically required by federal law. [A Missouri law] authorizes taxpayers and state legislators to sue state and local officials who flout its restrictions.”

Buying insurance through the new online marketplaces is like buying a plane ticket from a website. But some of the uninsured don’t have great Internet skills. They would benefit from having someone show them the different plans offered on the exchange and explain how much each would cost them. Josephine P. Waltman, a county health official in Missouri said, “I would love to do that.” But, by law, she can’t.

In contrast, ads are running on television in Colorado comparing buying insurance through the state marketplace to winning the World Series. Unlike Missouri (and Maine) both Republicans and Democrats in Colorado supported running their own health exchange. Both in ads and person-to-person, information is being shared about how people can benefit.

With so many false stories out there about Obamacare, sometimes people like what they hear when another label is used.

That’s what happened in Kentucky. “A middle-aged man in a red golf shirt shuffles up to a small folding table with gold trim, in a booth adorned with a flotilla of helium balloons, where government workers at the Kentucky State Fair are hawking the virtues of Kynect, the state’s health benefit exchange established by Obamacare,” reported the Huffington Post. “The man is impressed. ‘This beats Obamacare I hope,’ he mutters to one of the workers.”

No one told that Kentucky man that the plan he liked actually was a key part of Obamacare. But he and others hearing about it and walking away with swag, like a popular totebag with the logo of Kentucky’s health exchange, will be signing up for coverage.

Costs for buying health insurance, without taking the financial aid into account, look better in states where the state government has been involved. According to a blog post by Washington state’s insurance department, “Many people will see rates similar to what they’re paying now, or in some cases, lower — and with substantially better benefits. We’re definitely not seeing the huge rate increases that some insurers had predicted.”

California government was active in negotiating rates with insurance companies. Thus Californians will have rates that were less than predicted.

Unfortunately, these state differences mean a lot of people in some places will lose out. Texas, which has the highest rate of uninsured — 24 percent — isn’t using its state government’s resources to negotiate better rates or to publicize how the system works.

Texas is a long, long way from Massachusetts, which, under Romneycare, has only 4 percent without health insurance. Maine, with about 10 percent without insurance, is far closer to our fellow New England state.

Maine can do better if Gov. Paul LePage would do more to publicize the exchanges, explain the system, and encourage the eligible uninsured to sign up. Others are stepping in, like Maine’s Consumers for Affordable Health Care, which offers information on its helpline, 1-800-965-7476, and website.

In every state, health insurance marketplaces open Oct. 1, and they’ll have information about rates and financial aid. But how many people use them will depend a lot on what they know.

Amy Fried

About Amy Fried

Amy Fried loves Maine's sense of community and the wonderful mix of culture and outdoor recreation. She loves politics in three ways: as an analytical political scientist, a devoted political junkie and a citizen who believes politics matters for people's lives.