The GOP has one thing right. State-run government works better than federally administered programs. Where they went wrong with Obamacare was not letting their states run it. While Obamacare has not even begun its full implementation, the GOP is first to cackle it is dead already. Hardly. The heart of Obamacare is beating right where it was supposed to, in state-run exchanges. That success was in spite of GOP efforts that mightily strived to kill it off.
State exchanges, with several exceptions, showed the rest of the U.S. how Obamacare was supposed to function, state-managed and state-run. The New York Times recently ranked Colorado¹s exchange as the fourth best in the nation in meeting its goals for sign-ups. Obama last week said that one-half of the 1 million sign-ups came from the 14 state exchanges.
While Obamacare permitted and funded states to set up their own marketplace exchanges, or to develop their own Web sign-up systems, 36 mostly Republican-dominated states chose to leave implementation up to the federal government and they dumped their citizens into its flawed Internet system. Fourteen mostly Democratic-dominated states created and now run their own marketplaces.
Twenty-six states, mostly GOP controlled, also refused to expand Medicaid. Eight GOP governors did expand Medicaid or found alternatives. There is fallout from those not expanding Medicaid. Eight million (of which 1.4 to 1.7 million are in Texas) of the 14 million near-poor uninsured in the U.S. who earn too much for traditional Medicaid and too little to participate in the marketplace exchanges fall into the gap and must continue to seek charity care in hospitals, shifting health care costs to state government budgets and to the insured who will pay higher premiums.
Obamacare allows states to use federal money to provide their own alternatives to Medicaid. Arkansas took up the offer, set up the exchange, and subsidized the near-poor¹s participation. Texas, with the highest rate of uninsured, has not offered any solution whatsoever. They refused set up their own exchanges, failed to expand Medicaid, closed their high risk pool and sent insurance applicants to the federal site while their constituents most in need of the program have become their collateral damage.
Fourteen states have enacted “navigator suppression laws,” restricting the ability of trained helpers to assist sign-ups. Oklahoma banned them and Florida does not let navigators in certain social services agencies.
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