Monday, November 18, 2013


Well, here's the start of a pro-Obamacare pushback campaign: a Washington Post op-ed, by the governors of Kentucky, Connecticut, and Washington State, titled "How We Got Obamacare to Work."
... People keep asking us why our states have been successful. Here's a hint: It’s not about our Web sites.

... The Affordable Care Act has been successful in our states because our political and community leaders grasped the importance of expanding health-care coverage and have avoided the temptation to use health-care reform as a political football.

In Washington, the legislature authorized Medicaid expansion with overwhelmingly bipartisan votes in the House and Senate this summer because legislators understood that it could help create more than 10,000 jobs, save more than $300 million for the state in the first 18 months, and, most important, provide several hundred thousand uninsured Washingtonians with health coverage.

In Kentucky, two independent studies showed that the Bluegrass State couldn't afford not to expand Medicaid. Expansion offered huge savings in the state budget and is expected to create 17,000 jobs.

In Connecticut, more than 50 percent of enrollment in the state exchange, Access Health CT, is for private health insurance. The Connecticut exchange has a customer satisfaction level of 96.5 percent, according to a survey of users in October, with more than 82 percent of enrollees either "extremely likely" or "very likely" to recommend the exchange to a colleague or friend....
That's great. I hope it helps change the narrative from "Obamacare sucks" to "Obamacare's problems are primarily matters of implementation, and they can be solved." But this is a reminder that, because states were allowed not to implement Obamacare in a uniform way, and because the rollout at the federal level was so poor, the program is part of a balkanization trend in America.

I know that a lot of gay marriage supporters think marriage equality is eventually going to be recognized as a fundamental American right, like the right to interracial marriage, but I find it unimaginable that the reddest states are going to accept gay marriage via legislation or referendum anytime in the foreseeable future, and if it comes via the courts, especially the Supreme Court, I think there's simply going to be noncompliance -- which could turn ugly if the federal government tries to do anything about it. Consider the number of states where, right now, the feds are unable to get the same-sex marriages of National Guard members recognized, even though the state National Guards ultimately report to the president.)

Abortion is readily available in some states and all but illegal in others. There's gun control in the bluest states and a gun free-for-all in most of the others. They're fracking the bejeezus out of Pennsylvania while New York holds out, at least so far, just across the border. On hot-button issue after hot-button issue, a national consensus is not evolving.

Many of the smart people who laughed at Republican attempts to repeal Obamacare now think it's on life support, quite possibly subject to repeal in the near future by veto-proof majorities that include terrified Democrats. Yeah, possibly -- possibly the Republicans whining about policy cancellations are willing to throw all the people who can now get insurance for the first time off the rolls, because those people are, y'know, the wrong kind of people.

But I wonder if ways will be found to sustain some form of the Obamacare system in states where it's working and is not politically toxic. If that happens, it's probably a better fit with what America has become than a nationwide system. Because we really are two nations now, irreconcilable and divisible.


UPDATE: I seem to have set off a serious discussion at BooMan's place.


Victor said...

"Because we really are two nations now, irreconcilable and divisible."

And sadly, no divorce is pending.

aimai said...

I think the long term trends are better than you think, SteveM. I don't think Gay Marriage is at all comperable to health insurance but actually I think we will see the legalization of Gay Marriage in the reddest of red states in pretty short historical order. Why? Because it will either come out of the state level entirely as super state organizations and entitites--like the Federal Government and national employers--demand it or because Red state whiners will give up worrying about legalization/not legalization and retire to pure demonization.

As for health care--even if the exchanges make signing up difficult in a year or two pure self interest will push lots of red staters onto the exchanges or into subsidized health care and once that happens it will be the end of "end" obamacare and the start of the attempt by republicans to take credit for it. As for medicaid--sure red states will continue to refuse to expand it for a while longer but eventually the dems will figure out a new workaround. To me its a HUGE breakthrough that Medicaid in sane states has been expanded to 133 percent of poverty line. Its like a dam breaking after which it will be possible to expand it to higher and higher levels so that more and more people just automatically get enrolled in health care when they need it most.

Luigi said...

Anybody see this besides me?

Ten Bears said...

Two nations now: Cascadia!, and everything east of The Rockies we don't need.

As for the ACA (stop calling it "Obamacare", it's racist and when you use it the white dogs win), here in Oregon the web-site may suck but we are otherwise showing top numbers across the board. The only reason California and New York show better is the larger populations.

No fear.

aimai said...

Yay you for the link. I'll check it out. Booman lost me earlier today when he turned out to be a stone cold conspiracy theorist on the Kennedy assasination. But he regains my trust when he links to you.