WASHINGTON (AP) — President Barack Obama's health care law has become a
tale of two Americas.
States that fully
embraced the law's coverage expansion are experiencing a significant drop
in the number of uninsured residents, according to a major new survey
released Tuesday. States whose leaders still object to "Obamacare" are
seeing much less change.
Well-Being Index found an overall drop of 4 percentage points in the share
of uninsured residents for states accepting the law's core coverage
provisions. Those are states that expanded their Medicaid programs and
also built or took an active role managing new online insurance markets.
The drop was
about half that level — 2.2 percentage points — in states that took
neither of those steps, or just one of them.
that implement the law's major mechanisms are seeing a significantly
greater decline in their uninsured rates," said Dan Witters, research
director for the poll.
expansion mainly helps low-income uninsured adults in states accepting it.
Insurance exchanges operate in every state, offering taxpayer-subsidized
private coverage to people who have no health plan on the job.
nation were two southern states where the law has found political support.
Arkansas saw a drop of about 10 percentage points in its share of
uninsured residents, from 22.5 percent in 2013, to 12.4 percent by the
middle of this year. Kentucky experienced a drop of nearly 9 percentage
points, from 20.4 percent of its residents uninsured in 2013, to 11.9
poll's margin of sampling error is higher for smaller states, Witters said
Gallup has a high level of confidence that the numbers represent real
The poll found
contrasts among states that share a border, but have taken different paths
politically on the health care law.
— While Arkansas
had the 10-point decline in its uninsured rate, the drop in Tennessee was
just 2.4 percentage points.
— The uninsured
rate in West Virginia fell 5.7 points after the state agreed to Medicaid
expansion, but there was no change for neighboring Virginia, where
Democratic Gov. Terry McAuliffe has been blocked by a Republican-led
uninsured rated dropped 6 percentage points with Medicaid expansion and a
state-run exchange, while Utah's didn't budge. That state has a
federally-run exchange and is still weighing whether to expand Medicaid.
It's unclear if
emerging disparities among neighboring states will start to shift the
hardened lines in the political debate over health care. Americans remain
divided over Obama's signature program, with opponents clearly
Robert Blendon, a
public opinion analyst at the Harvard School of Public Health, said
immediate shifts are unlikely. That's because negative views about the law
are driven by people who already had insurance. They worry that the
coverage expansion will raise their premiums or compromise the quality of
care they receive.
"Why isn't the
bill more popular?" asked Blendon. "Rightly or wrongly, people who are not
directly aided by it are worried."
The Gallup survey
found some coverage gains in several major states opposing the law that
were also the focus of sign-up campaigns by the Obama administration and
its supporters. Texas saw a drop of 3 percentage points in its uninsured
rate, while Florida saw a slightly higher decline.
Some blue states
that already had high levels of insurance coverage made little headway.
The poll found hardly any change in Massachusetts and Vermont.
In deeply red
Kansas, the uninsured rate actually went up by 5 percentage points this
year. Witters said Gallup is taking a closer look at that finding, and
it's not clear if it represents an anomaly.
survey is important because it combines the quick turnaround of media
polls with extensive outreach usually seen in government research.
Pollsters interview 500 people a day, 350 days a year.
The 2013 margin
of sampling error for most states is plus or minus 1 to 2 percentage
points, but it is as high as plus or minus 3.5 points for states with
smaller population sizes, such as Wyoming, North Dakota, South Dakota,
Delaware, and Hawaii. For midyear 2014 results, the error range increases
to as high as plus or minus 5.0 points for these smallest states.