A new map released in the New York Times a few days ago show us in detail what many people already knew: Red states have almost completely failed to provide health insurance for their populations. There are caveats, but there is a clear correlation between “states that consistently vote for Democratic presidential candidates” and “states that have reduced their uninsured rate to somewhere below 14%.”
Intriguing Caveats
Because the map was laid out by county, we can look at specific counties within otherwise-blue states that have particularly high rates of uninsured.
- Menominee County, Wisconsin, for example, is an Indian reservation and the least-populated county in the state.
- Imperial County, California, has a massive farm-working immigrant population and the second-highest unemployment rate of any county in the USA.
- Yakmia County, Washington mixes the two: more than a third of the county is a massive Indian reservation, and it’s the country’s ‘apple basket,’ being again farmed by a large immigrant population.
- The single outlier, Tulare County, California has a rate that is artificially inflated due to a massive 21,000-person backlog of applications for MediCal that the county has been unable to process.
Similarly, there are interesting caveats within the red states as well.
- Within Alabama, exactly one county managed to achieve a single-digit uninsured rate: Shelby County, just outside of Birmingham. It also happens to be one of the wealthiest counties in the United States (88th out of 3,143 counties in the US), and one of the whitest counties in Alabama (84%).
- In Texas, five counties made the distinction: King County has less than 300 people in it and could easily be a statistical anomaly, and the other three — Williamson, Denton, Rockwall, and Collin — are the big cities of Austin, Dallas, Fort Worth, and Arlington.
- In Georgia, the single-digit target was hit in the counties of Cherokee and Forsyth (55th and 68th most wealthy; 82% and 83% white), Fayette (33rd/72%), and Oconee (which for some reason doesn’t appear on Wikipedia’s list of the wealthiest counties despite having average household income putting it at 59th, and is 86% white.) These counties comprise what could reasonably be labeled “Where the white people who work in Atlanta commute from.” Also making the list: Columbia County, a.k.a. “Where the white people who work in Augusta commute from,” 76% white.)
- The one county in Tennessee that pulled off the single-digits: Williamson, the 17th wealthiest county in the country and 87% white. (They commute into Nashville.)
In simple terms, the places that ‘failed’ in the blue states have large non-citizen populations and tend toward high unemployment due to many families being dependent on seasonal farm work. The places that ‘succeeded’ in the red states…are the suburbs just outside the big cities, where wealthy, mostly white people live. These places had very low rates of uninsured before Obamacare as well.
The Political Cause: The Medicaid-Obamacare Connection
The other factor on the health-insurance map isn’t immediately obvious, but when you see it, is terribly clear. Before the Affordable Care Act, there were unreasonable coverage limitations under Medicaid. Obamacare offered a coverage expansion — but 22 states turned down that offer.
Every single state that accepted Federal ‘Obamacare’ Medicaid coverage expansion has less than 14% of their population uninsured, even the ‘rogue’ Republican-governed states like Florida and Wisconsin.
Every single state that turned down the Medicaid expansion — all Republican, all for political purposes — has failed that benchmark, and the rates of uninsured are essentially unchanged in those states.
The same analytics agency also released a study on what the rates of uninsured would have looked like if the Medicaid expansion were mandatory, rather than optional. The results speak for themselves.
Featured image courtesy of Ted Buckner via Flickr; available under a Creative Commons license.
