Surprise: Fighting Health Coverage Works!

The most-discussed if least unexpected news of the morning is additional evidence that states which cooperated with the Affordable Care Act by setting up their own purchasing exchanges and taking advantage of the optional Medicaid expansion are reducing the ranks of the uninsured much more rapidly than states which didn’t cooperate–more than three times as rapidly, according to data from Gallup.

You could certainly say this particular result of Obamacare was unintentional. In the House-passed legislation, the federal government would have run all the health insurance purchasing exchanges. And more obviously, the Medicaid expansion was not designed to be optional. The state-run exchanges have mostly (though not always) turned out to be more effective than those operated by the feds against the will of the “host” state. It’s not entirely clear how much damage state obstruction and propaganda have wrought in discouraging Obamacare enrollment. But the rejection of the Medicaid expansion in states with the highest uninsured rates has been a very big deal. Remember the role of sabotage next time you read that the Affordable Care Act isn’t working as planned.

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Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.