- The Washington Times - Monday, August 10, 2015

States that fully embraced Obamacare have done better at cutting their rates of uninsured, according to a new Gallup survey that suggests the law is having its intended effect of getting more coverage for more people.

Arkansas and Kentucky led the way, cutting their ranks of uninsured by 13 percent and 11 percent, respectively, over the last two years, or just as the law fully phased in with its state-based exchanges and tax subsidies to help Americans afford plans, and with broader Medicaid coverage.

Oregon, Rhode Island and Washington also saw at least a 10-point drop, Gallup said, and Rhode Island and six other states — Massachusetts, Vermont, Minnesota, Iowa, Connecticut and Hawaii — now have at least 95 percent of residents covered.

“Previously — from 2008 through 2014 — Massachusetts had been the only state to be at or below this rate,” Gallup said.

States that saw sharp decreases tended to take on both pillars of President Obama’s signature overhaul, expanding Medicaid along the lines the legislation’s sponsors hoped, and running their own health exchanges, or marketplaces instead of relying on the federal HealthCare.gov site.

Those that embraced both aspects saw a 7.1-percentage-point drop in the uninsured population, on average, compared to 5.3 points in states that took on one or neither of the provisions.

While the survey suggests Obamacare is meeting its goal of reducing the ranks of uninsured, practical and political challenges remain.

Republican critics say the law forced people to get coverage under the “individual mandate,” so the increased number of insured isn’t a sign of a beloved law. But now those customers forced to get coverage could see premium hikes and high deductibles, lessening the appeal of their new plans, those critics charge.

And Medicaid, which helped boost the success rate, may be close to topping out, Gallup said. Some 28 states plus the District of Columbia have expanded their programs under Obamacare, while Montana is waiting for federal approval of its plans, Utah is considering expansion, and Alaska Gov. Bill Walker recently decided to expand his state’s program unilaterally.

Yet GOP leaders in many of the rest of the states have been dead set against expansion or embracing Obamacare in any way.

“While some additional progress can be made, therefore, in the reduction of the uninsured rate via further Medicaid expansion, this mechanism for reduction has likely reached most of its potential unless additional states choose to implement it,” Gallup said. “As such, the marketplace exchanges that enable people to select and purchase their own plan directly from insurers will likely be the primary means by which the national uninsured rate would be reduced in the immediate future.”

Those exchanges got a boost from a 6-3 Supreme Court decision last June that held the IRS can continue to pay out subsidies to exchanges in every state, despite contested language in the 2010 law.

However, new audits have raised questions about potential fraud in the subsidy system, and a handful of state-run exchanges are struggling to remain viable, meaning they may need to migrate over to the federal HealthCare.gov system.

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