JEFFERSON CITY, Mo. (AP) — Residents in some parts of the
U.S. are signing up for health care coverage at a significantly greater
rate than others through the new online insurance marketplaces now
operating in every state.
The discrepancy may trace back to the political leanings of their elected
Newly released federal figures show more people are picking private
insurance plans or being routed to Medicaid programs in states with
Democratic leaders who have fully embraced the federal health care law
than in states where Republican elected officials have derisively rejected
what they call "Obamacare."
On one side of the political divide are a dozen mostly Democratic leaning
states, including California, Minnesota and New York. They have both
expanded Medicaid for lower-income adults and started their own health
insurance exchanges for people to shop for federally subsidized private
On the other side are two dozen conservative states, such as Texas,
Florida and Missouri. They have both rejected the Medicaid expansion and
refused any role in running an online insurance exchange, leaving that
entirely to the federal government.
The new federal figures, providing a state-by-state breakdown of
enrollment in the new health care program through November, showed that
the political differences among leaders over the initiative are turning
into differences in participation among the uninsured.
Even though many conservative states have higher levels of poverty and
more people without health coverage, fewer of them may receive new
insurance, said Dylan Roby, an assistant public health professor at the
Center for Health Policy Research at the University of California, Los
With the patchwork implementation of the federal health care law, "the gap
will exacerbate," Roby said
The U.S. Health and Human Services Department reported this week that
364,682 people had signed up for private coverage through the new health
insurance marketplaces as of Nov. 30 and an additional 803,077 had been
determined eligible for Medicaid.
But the rate of residents gaining health coverage was more than three
times as great in the states embracing the federal health care law than in
those whose leaders have resisted it.
In the dozen states embracing the overhaul, more than 50 percent of those
who applied for coverage picked an insurance plan or were eligible for
Medicaid. That rate was barely 15 percent in the two dozen states that
aren't cooperating in the implementation of the federal health care law.
"It's very frustrating," said U.S. Sen. Claire McCaskill, a Missouri
Democrat who voted for the federal law only to see it twice rebuffed in a
statewide vote and repeatedly rejected by her home state's Republican-led
"The political point has trumped the services that Missourians need,"
In Texas, which has the highest rate of uninsured residents in the U.S.,
the GOP-controlled state Legislature opted not to create a state-run
insurance marketplace and Republican Gov. Rick Perry also declined to
expand Medicaid to cover more of the working poor. As of the end of
November, just 14,000 Texans had signed up for insurance through the
federally run marketplace and fewer than 17,000 of the nearly 245,000
applicants on the exchange had been determined to be eligible for
State Rep. Trey Martinez Fischer, a Democrat from San Antonio who chairs
the Mexican American Legislative Caucus, said he nonetheless remains
optimistic about the meager numbers.
"To know that there are people who, despite those odds, are still
enrolling is encouraging," Fischer said.
In California, which also has a high uninsured rate, more than 107,000
people had picked an insurance plan through the state-run marketplace as
of the end of November, and nearly 182,000 others had been determined
eligible for Medicaid. That means nearly two-thirds of the 448,133
individuals who applied through the insurance exchange could gain some
sort of coverage.
Federal grants in California have helped finance TV and radio commercials,
billboards, bus signs and town hall meetings encouraging people to
participate in the new health insurance marketplace.
That sort of promotion has been lacking in many of the states that have
refused to run their own insurance marketplaces.
In Missouri, where a law forbids the government from implementing an
insurance exchange, a coalition supporting the marketplace delayed its
promotional campaign because of the technical troubles that marred the
launch of the federal website.
"We didn't want to drive people to a frustrating experience," said Thomas
McAuliffe, a policy analyst at the nonprofit Missouri Foundation for
Now, advocates for the federal law face a steep challenge to implore
people to sign up by Dec. 23, which is the deadline to be covered by
health insurance policies that take effect in January.
"When we look at enrollment numbers, we're obviously going to lag behind,
because in many parts of the state there's still a sense that Obamacare is
not going to help me — even by the people it's going to help the most,"
Heather McCabe, an assistant professor of social work at Indiana
University-Purdue University Indianapolis, said the low enrollment numbers
in many states raise questions about whether people are turned off by the
problematic website, don't know they're eligible to use the exchange or
have found the policies unaffordable.
"If the answer is that people still don't understand what the exchange is
and how to use it, then the answer is we need to do education and help
people better access the system," she said. "But if the answer is that the
premiums are too high, then we have an issue that's a little more
difficult to deal with."