“This law is working, and it’s going to keep doing it,” President Obama said this morning during his press conference celebrating the Supreme Court’s decision to spare the Affordable Care Act from partial annihilation. As much as Republicans might protest otherwise, the comment was pretty much a straightforward factual statement, at least if you judge health reform against its primary goal of reducing the uninsured rate.
One of the amazing bits about Obamacare is just how well it seems to be succeeding in parts of the country that have rejected its core pieces. Remember that the last time the court passed judgment on the ACA, it ruled that states had the right to turn down its Medicaid expansion. Since then, 21 states have abstained from the giant wad of federal cash being offered to them in order to cover more of their low-income population. And yet, the uninsured rate is still down by about one-third in the opt-out states, as shown in this chart from the Urban Institute that Paul Krugman has been linking to. That’s not quite as dramatic as the nearly 50 percent drop seen in states that embraced the Medicaid expansion, but it’s impressive nonetheless.
As Krugman has noted, some conservatives will try to argue that the improving economy is responsible for expanding health coverage. And I guess you could argue it’s purely a coincidence that the uninsured rate started rapidly dropping around late 2013, right when Obamacare’s main provisions started going into effect. And maybe, if you do enough mental somersaulting, I could sort of see how it makes sense that our incomplete, slow-moving jobs recovery would bring us a historically low uninsured population. But the much more simple answer is that a law designed to help people get insurance is in fact helping people get insurace—even in states that have tried their best to sabotage it.