Changes To Obamacare Will Hurt Red States More Than Blue

Trump and the Republicans weren't able to repeal Obamacare (the Affordable Care Act), but they did make some changes to it. Ironically, those changes will hurt the residents of red states more than blue states.

Here's what Ronald Brownstein said about this in The Atlantic:

The battle over health care is moving to the states.

The most immediate effect of the recent steps taken by Donald Trump and congressional Republicans to unravel the Affordable Care Act will be to create an even deeper gulf between red and blue states in the availability and quality of health insurance. An array of blue states are exploring ways not only to blunt Trump’s moves, but also to reach beyond the ACA with new mechanisms to expand coverage. Simultaneously, many red states are leaning into the rollback—both by seeking to limit access to Medicaid, and by embracing Trump’s efforts to deregulate insurance markets in ways that will restore the pre-ACA separation between the healthy and sick.

“In the states that don’t act to strengthen their regulation, you are going to see these non-group-insurance markets weaken” by eroding the risk-sharing between the healthy the and sick that the ACA required, Linda Blumberg, a fellow at the Urban Institute who closely studies the law, says. “It really takes us major steps back to where we were prior to [the law].”

Two big moves from Trump and congressional Republicans are expanding this wedge between the states. The first is the tax bill’s provision repealing the ACA’s individual mandate, which required all Americans to buy insurance. The second is the administration’s recent proposal to significantly expand the availability of “short-term” health plans that don’t guarantee minimum benefits or prohibit discrimination against consumers with preexisting health problems.

Those two measures encourage healthier people to leave the ACA exchanges, and either purchase the skimpy, but less expensive, short-term plans or forego insurance altogether. In a recent study, the Urban Institute projected about 9 million people would abandon the exchanges for one of those options. That would leave an older and sicker population remaining on the exchanges, which would raise premiums and reduce access to care, particularly for those who earn too much to qualify for the federal subsidies the ACA established.

But states have a surprising degree of autonomy to block Trump’s moves, and blue states are positioning themselves to do so. Five Democratic-leaning states in the Northeast already functionally prohibit the sale of short-term plans, and several others—Washington state has moved the quickest—may join them with regulatory or legislative limits.

Even more ambitiously, about a half-dozen states are examining ways to restore a mandate on individuals to buy insurance. The conversations are most advanced in Maryland, where state legislators are racing against an April 9 adjournment date to pass an individual mandate with an intriguing twist: The legislation would allow anyone without insurance to funnel their penalty into an account they could apply to buying coverage the next year.

As Maryland demonstrates, blue states are looking beyond blocking Trump’s moves and moving toward expanding the ACA framework. Several states are exploring proposals to restore a public option to compete with private insurers—a top liberal priority dropped from the ACA amid resistance from the insurance industry and centrist Democrats. Through the new proposals, Democrats would allow the uninsured to buy into state Medicaid plans. . . .

The Urban Institute forecasts that the administration’s moves against the ACA could increase insurance premiums on the exchanges by fully 18 percent next year. Larry Levitt, the senior vice president for health reform at the Kaiser Family Foundation, told me that Congress could offset most of that possible increase by passing “reinsurance” legislation from Republican Senator Susan Collins of Maine and Democratic Senator Bill Nelson of Florida. Their bill would reimburse insurers for covering the most expensive patients. But with the administration privately demanding exorbitant concessions in exchange for accepting such a plan, the measure’s prospects appear dim.

That means health insurers are likely to announce major premium increases during the next ACA open-enrollment period—just weeks before the midterms. In a January national Kaiser poll, three-fifths of Americans said they would blame Trump and the GOP for any further ACA problems. By creating the conditions for big premium hikes this fall, Republicans in Washington and the states appear determined to test that proposition.

The chart above, using information from a Kaiser Family Foundation Poll, was done between January 15th and 21st of a random national sample of 1,215 adults, with a 3 point margin of error.