What happens when a state tries to make Obamacare work -- or not work

[unhappycamper]

http://www.latimes.com/business/hiltzik/la-fi-mh-heres-what-happens-20140801-column.html



Bottom of the cracker barrel? Mississippi Gov. Phil Bryant hasn't done anything to implement the ACA, and his state's statistics show the results.

What happens when a state tries to make Obamacare work -- or not work
Michael Hiltzik
8.1.2014

There were signs almost from the start that the great unknown about the Affordable Care Act was how effectively individual states would implement the law. The question got more complicated after the Supreme Court turned one of the key provisions, the expansion of Medicaid, into a state option.

Now, as the evidence starts rolling in from the states, it is even more clear that their policies make all the difference in the world. Let's start with Kentucky, a weird case. Its congressional delegation is 7 to 1 Republican, with Rep. John Yarmuth of Louisville the only Democrat; the others are all firmly committed to the GOP hard line of repealing Obamacare.

But under Democratic Gov. Steve Beshear, Kentucky has been one of the most enthusiastic and effective implementers of the ACA -- so much so that Sen. Mitch McConnell, the Senate minority leader, who is facing a tough Democratic challenge, has suggested that Kentucky's state insurance exchange can live on even if Obamacare dies. Experts say he's wrong about that, by the way.

How effective is Kentucky's effort? Examine the accompanying charts, which show the state's population of uninsureds, county by county, before (left) and after (right) the ACA. Some of the state's poorest counties, including the infamous Harlan County, went from recording the highest levels of uninsured residents to the lowest. According to Larry Kissner, a top state health official, Medicaid reimbursements, which help keep hospitals running, have moved higher, too.



Uninsured rates have dropped significantly across Kentucky, which has implemented the ACA well. Rates are shown before the ACA (left), and after (right).