Feb 24, 2015

The Affordable Care Act (a.k.a. "Obamacare") and the Reverse Income Effect

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The Medicaid Expansion Under the Affordable Care Act

The Affordable Care Act, passed in 2010 and initially referred to as "Obamacare" by opponents, sought to expand healthcare access by regulating the healthcare insurance industry and lowering costs of healthcare and heath insurance premiums for consumers.  With the overlapping goals of covering more people and lowering the cost of healthcare, the ACA required states to expand Medicaid eligibility requirements to allow for more individuals to qualify for Medicaid.  Medicaid provides health insurance coverage at no cost for low income families with children.  Medicaid is funded by general tax revenues that are given to the states who administer the Medicaid program.  The ACA required states to expand coverage of Medicaid or else face loss of Medicaid funds altogether.  The U.S. Supreme Court ruled in 2012 that the provision in the ACA requiring states to expand their Medicaid coverage or else lose Medicaid funds was too "coercive".  Despite the promise of the federal government to cover 93-100% of the cost of covering additional people, many conservative states, in ideological and partisan opposition to the law and President Obama, declined the expansion. This is how we get to the current patchwork of expanded Medicaid coverage across the country today.  These states argue that the state cannot afford the expansion and does not support the greater role of the federal government in healthcare.  The map above shows which states have accepted the federal funding to expand Medicaid eligibility and which states have rejected the funds and expansion. The link below from Kaiser provides a more detailed description state by state.


Without the expansion limited groups qualify for Medicaid.  Of course, there is an income limit, but what most may not know is that, under the past Medicaid eligibility rules and the current rules of states that declined the expansion, only very low income individuals that have children, individuals that qualify for disability under extreme financial hardship, and low income pregnant women may qualify for Medicaid.  The Medicaid expansion opens up eligibility to more by allowing for low-income adults (with or without children) to qualify for the coverage.  Because the Supreme Court ruled that it must be state choice to expand Medicaid individuals of similar economic circumstances in two different states are under different eligibility guidelines. For example, "Tom" in New Mexico can qualify for Medicaid and have access to doctors and hospitals despite his low income, while "Sam" in Georgia does not have that same access, although both do not have children and unable to afford healthcare without financial assistance.

While some conservative/Republican dominated states in terms of party loyalty or leadership have changed their minds and accepted the expansion, most have not.  As can be seen in the interactive maps provided by The New York Times at "We Mapped the Uninsured", the states that have declined the expansion are typically conservative in their politics, with Republicans usually dominating voting for key political offices, such as Governor or the state legislature. 

The Reverse Income Effect


There is another dynamic to the Medicaid expansion issue that is of interest.  This is the phenomenon studied in Political Science known as the "reverse income effect".  Notice that the dichotomous display of color in the expanded/not expanded Medicaid map above is very similar to the pattern in the Presidential election results maps for 2008 and 2012.






In most cases the states on the Medicaid map that did NOT expand Medicaid, are the "red" states on the presidential election maps that depict which candidate, Republican or Democrat, that the state's electoral votes were awarded to.  This, of course, is typically determined by the winning candidate of the popular vote count in that state.  The New York Times maps show that the states with the highest number of uninsured are these very red states.  Also important, is that these states had the highest number of uninsured to begin with, and still do since the states have chosen not to expand Medicaid under the ACA.  Perhaps more red states in the near future will opt in to the expansion under the increasing pressure of the uninsured.

This similarity brings up the political science phenomenon of the "reverse income effect".  If we look at data depicting voting patterns among low income and then among high income individuals we see that high income individuals are more likely to vote Republican, while low-income individuals are more likely to vote Democrat.  This is usually explained by the fact that Republicans are conservative in ideology, preferring lower taxes on businesses and individuals, even on high income earners, as well as less regulation on businesses.  Higher income make up a higher percentage of business owners.  Democrats tend to be more supportive of programs and regulations designed to benefit or protect consumers and low-income individuals.  This, perhaps explains the increase in support for Democrats as income decreases.  In the 2012 Presidential Election, roughly 60% of voters earning less than $50,000 annually voted for President Obama, the Democratic candidate.  This is true for previous and recent presidential elections.   The percentage may have been higher had more low-income individuals voted in the election.  Voter turnout rates tend to be lower among lower income level groups.

The "reverse income effect" notes that while lower income individuals tend to vote Democratic, and higher income individuals Republican, the same is not true if we look at statewide data against electoral vote outcomes.  As the map to the left suggests when analyzed next to Presidential election outcome maps, the states with the lowest median income levels, the poorer states, tend to award Republican candidates more votes than Democrats for  the Presidency and various state-wide offices; while the states with median income levels in the higher ranges tend to award Democrats their electoral votes and votes for various state offices.  In the map above, the darker the blue shading, the higher the median income level of the state.  The light blue states have the lowest median income levels.  Notice that most, if not all, of the states depicting the two shades of light blue are the states that are considered to be conservative in ideological leaning and Republican  party dominated.  Therefore the lower the income level of the individual, the higher the probability of voting Democrat; but the lower the median income of the state, the higher the probability of the state giving electoral votes to the Republican.  This paradox is interesting but may be explained by the presence of other variables that influence voting.  For example, Republican dominated states are usually more socially and culturally conservative in terms of voter makeup, which may explain why these states, despite having lower incomes on average, tend to allow for Republican victories.  Additionally, minorities (especially blacks and Latinos) tend to vote Democratic for economic and political reasons, such as support for civil rights protections.  Blacks and Latinos make us a disproportionately large share of low-income earners and those living below the poverty level, which is one explanation for why votes among low-income earners tend to go to Democrats, but why statewide data suggests the opposite, higher probability of voting Republican.  

Back to the Medicaid Expansion 



Now looking at the Median income level map in comparison to the "Expand/Don't Expand Medicaid" map, it is apparent that the states that may be most in need of expanding Medicaid coverage in terms of median income levels and inability to afford healthcare without assistance, are the very states that rejected the federally funded expansion of Medicaid under the Affordable Care Act.  Therefore, the states that will not expand Medicaid have a disproportionately higher share of individuals who will not qualify for Medicaid under the current requirements but cannot afford health insurance, or even health care for that matter without assistance, assistance which their state has rejected.  

Impact of Rejecting the Medicaid Expansion on Hospital Access in Rural Communities


Citizens in rural areas, which are largely found in lower median income and conservative states will also begin losing access to hospitals and emergency services if the state continues to reject expansion of Medicaid. In the crafting of the ACA, rural hospitals agreed to lower their Medicare reimbursements in exchange for getting more patients with health insurance under the act.  Rural hospitals a high percentage of health services that are provided to those with low-incomes who cannot then pay for those services.  Therefore, having insurance coverage for low-income, such as Medicaid, means that these hospitals will receive payment for the services that they are under obligation to provide when provided to someone that is low-income or poor. However, these rural hospitals are closing one by one in states that rejected the Medicaid expansion.  Rural hospitals are facing closure because they have been hit twice, in that they lowered their Medicare costs but are not receiving payment for services in return from individuals who would be able to pay for their healthcare, but for their state's decision to deny that individual Medicaid coverage.  The closing of rural hospitals means that many individuals in this nation will be, in many cases, as much as 40 miles from the nearest hospital and emergency room.  This could mean the different between life and death, or healthy or disabled for many in rural communities.  Again, the states most impacted by this, those composed largely of rural areas, tend to be the conservative/Republican dominated states that rejected the Medicaid expansion, and will, as a result, likely see hospital closures in those areas.  In Georgia, as of November 2014, five rural hospitals have closed and another six likely to close in the future. Since 2010, 43 rural hospitals have closed nationwide.  It is likely that this gap between Medicaid-Expanded/ higher-median-income states and Medicaid-not-expanded/low-median-income states will narrow as states that rejected the expansion will be pressured to reverse course.  This will only happen as the Affordable Care Act becomes less partisan and more time has passed since the act itself was passed.  (Source: http://www.usatoday.com/story/news/nation/2014/11/12/rural-hospital-closings-federal-reimbursement-medicaid-aca/18532471/)

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29 comments:

  1. When I first heard of Obama Care I had only the information my grandfather commented about. Sense he was against it I was against it without really knowing anything about Obama Care. After reading this article I know enough information about Obama Care that I support the act and hope Georgia joins the number of states that has accepted Obama Care. People who are living on low income and can not afford health insurance do need help because there health is just as important as anyone else's health.
    Whether a state is democratic or republic they should be trying to do what will positively help their citizens; like accepting a health care act that will allow more people to be able to afford health insurance. If hospitals are closing down this is endangering the state's citizens. The states responsibility is to protect all citizens and by not passing Obama Care they are endangering all citizens.

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  2. I feel like all classes (high,medium and low income) should support Obama Care because not everyone can afford it. The gov is only regulating to make the lives of individuals better so it supports both parties

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  3. We have individuals whom die everyday for this country everyday (armed forces). Their allegiance to our country is admirable. They understand the concept of "We are in this together". Rejecting Obamacare is their way of saying "I could care less about your health".
    Granted, Obamacare is primarily focused more on making sure people are covered than it does on addressing the cost of care in the first place. It does increase taxes and causes other peoples insurance premiums to rise. Many small buisnesses refuse to higher additional employees due to the 50-Employee Threshold; businesses must provide health insurance to their employees, if more than 50 employees. So, Obamacare definitely affects the job market. Many employers have also cut back on hours, so that employees are part-time.
    So, there are a lot of cons that come with Obamacare.
    The reason for Obamacare is provide medical insurance to individuals whom otherwise cannot afford medical coverage. Hmmmm.........

    I have something I'd like to address. The same people against Obamacare are generally against ALL low-income programs, such as; SNAP, TANF, etc.
    Many oppose these programs and make generalizations about individuals in these programs, considering them to be lazy or dependent on government. This is not always the case.
    Some of these people made bad decisions at the age of 18, they are now 31 and STILL suffering the repercussions of their actions; the only job that will hire them pays $7 an hour, and working full time, with 5 kids, they CANNOT make ends meet. They would like to do better, but struggling to get there.
    Why can't this person receive health insurance? Why can't they receive food stamps? I understand you are sitting over there with your $100k income and 3 cars-you don't want to pay additional taxes at the expense of this dad who CAN'T do better (unless he robbed someone or sold drugs). This brings me back to the Armed Forces; they put their life on the line for us, and you can't put a few dollars on the line for your fellow Americans to receive health care. That is very inhumane.

    Sorry for the rant. But I truly believe what could help lower costs in low-income programs, while creating less of a need for these programs, would be adding stipulations to receive the aid. For instance, in order for your food stamps to remain active, you HAVE to be either a Full-Time student, working 20 hours a week, or be actively involved in volunteering for the government weekly or monthly. This way, tax dollars won't go to waste! :) This way, someone can't call you lazy. And, if you are lazy you may not do any of the above and therefore won't receive the aid.

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  4. Jesse Saldana AriasMarch 12, 2015 at 6:09 PM

    I think all if not most states should accept Obamacare; its beneficial to most states. According to the article, “The Medicaid expansion opens up eligibility to more by allowing for low-income adults to qualify for the coverage.” Expanding Medicaid can help save lives and give lower income families the chance to see a physician. Not expanding Medicaid will only hinder America in the long run, especially citizens in rural areas.  The states that have denied Obamacare tend to be, “conservative in their politics, with Republicans usually dominating.” It doesn't matter if you're a Democrat or a Republican; we should come together and collaborate on important issues like this, to help better the US. 
    When it comes to passing Obamacare, Republicans always seem to care about themselves. I remembered reading an article on Yahoo, that said, "Republicans have repealed the Affordable Care Act 56 times." Waste of time, if you ask me. We spend millions of dollars on war, but can't seem to spend any money on public healthcare. Also, the Republicans have taken over the Senate, I wonder how that's gonna work out between a Democratic POTUS and a Republic senate. I’m not hating on Republicans,I’m not saying that Obamacare is the answer to our problems, but at least it’s a step in the right direction.

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    1. Jesse, I love how you said "We spend millions of dollars on war, but can't seem to spend any money on public healthcare." I couldn't have said it better myself! I feel as though America is focused on the wrong thing. Spending billions on war, then turn around and not help citizens with healthcare. It's quite backwards. Obamacare is definitely a step in the right direction.

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  5. I think the ACA has great intentions and provides fantastic benefits by making health care more affordable and available. I was not shocked to see the correlation between the state’s dominant party and the state’s decision to reject or expand Medicaid expansion. For example, that conservative Republican states, such as Georgia, would reject Medicaid expansion. However, I found the reverse income effect interesting as the opposite correlation occurred with income and party majority. State wide data proved that lower income states actually voted their electoral votes with a higher probability towards Republican. Although this reverse income effect does indeed have to take into account the additional factors of traditional social conservatism in particular states as well as minorities’ tendency to vote Democratic. It all converges by income level resulting in a reverse effect on majority party affiliation and the party, either more conservative Republican or more liberal Democratic, typically deciding to reject or expand Medicaid; a different twist to what a non-political scientist would assume.

    I think it’s devastating to our country that politics and rejection of Medicaid expansion is preventing so many from healthcare and proper life-saving institutions. The negative effects of states rejecting Medicaid expansion is costing citizen’s lives and hindering necessary emergency facilities like hospitals. The fact that USA has already lost 43 hospitals in just two years is scary considering the life endangering repercussions in each of those communities. I believe the states should look statistically at their citizens and if they have a majority of individuals who would qualify for Medicaid, the state should seriously consider expanding despite the state’s majority party or conservative views. If the public has a need, the state government should not hinder their ability to satisfy the need.

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  6. Shelby Gurrera GPC-NewtonApril 4, 2015 at 2:05 PM

    Overall, the Affordable Care Act seems like a great idea. It does have some down falls but it cannot be perfect. Many people cannot afford to pay for healthcare and do not qualify for Medicaid. The Affordable Care Act should eliminate that problem, if this was a perfect world. The thought that everyone could have health insurance is ideal. I believe that all states should expand Medicaid. It seems a bit odd that there is a direct correlation between the states that didn’t expand and their political party affiliation. I wonder if that is just because Congress is so dysfunctional that the Republican party chooses not to expand Medicaid through the Affordable Care Act simply because Obama came up with the idea. There really is no other reason that I can think of as to why some states choose not to expand Medicaid. I think that Medicaid expansion should be required or voted on by the people of the state. There should not even be an option to expand. If the expansion can help so many other people, why would the state not expand? It is not like the state would have to pay for the expansion their selves. Most of the expansion is covered by the federal government, at least 93 to 100 percent. For the first two years, the federal government pays 100 percent of it. There should not be diversity among the states when it comes to who will receive Medicaid and who will not. The fact that rural hospitals are closing down in some states proves that not expanding Medicaid affects more than just the people who would qualify for it if it were expanded. If people living in rural areas have to drive more than an hour a way to get to a hospital since the one near them closed down, they could potentially die in route. Hospitals closing down also affect the workers there. Many people are now out of a job. This hurts the economy in those states, which eventually will backfire on the overall economy of the United States. This is why Medicaid should be expanded in all states.

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  7. I think that Americans need to begin to use critical thinking skills when the government begins to introduce new programs or when it begins to alter existing programs. I was fully against the affordable care act until I began to read the provisions of it. It wasn't until I saw that these provisions can not only help the poor, but can help everyone. For example, it is incredibly important to maintain stability in health insurance. You don't want to be dropped from your health insurance because you got sick. The expansion of Medicaid is a lot more complicated. On the surface, it seems like this expansion will cost the federal government an untold amount of money and could raise our deficit, unless they raise taxes to cover it. While this is the case, the idea that the Aca can actually lower the price of health bills can be confusing and will probably only apply on an individual bases. I see the ACA as having to go through the constitutional "ironing" board so to speak, meaning that I can see law suits going to the Supreme Court over individual clauses (I.e. having to provide workers with birth control coverage.) people will always disagree with provisions in bills or acts, but the ultimate question is whether the government was given the right to do it in the constitution.
    -Ben Gagnon

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  8. Ajah Ochoa GPC

    There are some ironies with the ACA. One major irony is the fact that it is meant to help those who cannot afford healthcare, yet in states where this program would be most beneficial, it has been rejected and hospitals are closing. Another is the reverse income effect. While the election map and the Medicaid expansion map are very similar, when assessing how median income of a state affects its vote, lower- median income states vote Republican while higher- median income states vote Democratic. While lower- median income states, which would benefit from the expansion of Medicaid, vote typically conservative, conservative states typically reject the expansion. These facts are like magnets with the same charge repelling each other. This ultimately works against the best interest of residents in conservative states who cannot afford healthcare.
    Before reading this article, I was not aware of the reverse income effect. This effect further demonstrates how even though voters often identify with one party, their opinions on political issues do not side with or reflect the ideas of a single political party. It is interesting how much the election map reflects the Medicaid expansion map. This shows just how big a role partisanship plays in decision making. Although the expansion of Medicare is not widely accepted by the states, those negatively affected will most likely influence change.

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  9. Although those that oppose Obamacare do have somewhat valid points, it is obvious that the losses that will occur from refusing to expand Medicaid far outweigh them. If each state does not adopt the ACA, it leaves millions of Americans without access to healthcare when they need it. This includes infants, children, expectant mothers, etc. With the closing of more hospitals, even those with insurance will have to travel great distances to receive care. Any state that is refusing to expand Medicaid cannot ignore the truth much longer: denying Americans access to low cost healthcare will result in the death of us a nation. This issue transcends ideology and partisan values; this is about saving lives.

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  10. Im curious to know the Republican's initial response to The Affordable Healthcare Act. According to analytical examinations and statistics, would Romney's political policies been more effective than Obama's?...I wonder..

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  11. I think everybody should read the facts about the ACA before reaching any conclusion. Most of the people I came across have their opinion on ACA either based on their party affiliation or through their family’s perspective. Although there are some drawbacks and loopholes in it, for example, some companies may save money by choosing to pay penalty, instead of buying health insurance for their employees, or for some individuals the cost may be higher, but this part of the provision is pretty straight forward and if 100% percent of the cost to expand is covered by fed. Govt. for 1st three years and after that the fed. Govt. is required to cover 90% of the cost of the program, what can be the problem. All I can see is because someone’s partisanship many people’s health is neglected.

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  12. Elizabeth Butler
    Rejection of the Affordable Care Act appears to me to be a blatant display of political polarization. Although it conflicts with traditional conservative beliefs of minimal government intervention, it seems almost cruel to keep healthcare from those who could benefit from it. I was surprised to see that most states that rejected the expansion of Medicaid were the states with some of the lowest median incomes. Healthcare is like a carrot dangled in front of their faces in the Republican-dominated state government. Although Obamacare may go against Republican ideals, keeping medical assistance from people based on principle is unacceptable. Not accepting these grants from the federal government is a slap in the face to low-income families.

    I was shocked that rural hospitals are closing down in the states snubbing the ACA. The fact that the ACA could help keep these hospitals open is a tremendous benefit that cannot be overlooked, even by those who vehemently oppose this new “socialist” policy. Poorer rural towns cannot have people forced to travel an hour to the nearest hospital. Our country cannot revert back to the past simply because Obama was the one who introduced this legislation. Over 40 hospitals have already closed. How many more will have to shut down before a compromise is met?

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  13. I believe that the Medicade expansion is beneficial to the economy and those who are struggling. While there is now a large gap between the wealthy and the poor, expanding Medicade would help this gap close, but how? It would allow for those low income families or individuals be able to save their money or spend it on other things than the costly price of health insurance. It gives people the chance to build up more savings and be able to rise from the lower to middle class of citizens. Also, the relief of stress suffered from worrying about paying bills and other struggles that come with being low income, especially with a family, makes a larger difference than one may think. Stress can take a serious toll on a person’s mental and physical capabilities. This lack of stress helps improve the over-all health of a person, and makes it less likely for illness and the need to use health insurance. As discussed in the article, many states did not choose to accept the new Medicade reforms, and over time they will be able to see the differences of the effects of the reform. Although all of the states didn’t accept this reform (shown in the image), I believe that eventually all of the states will accept the new Medicade reform.
    I find it interesting the correlation between those states that did not accept Medicade and the states who voted Republican in the last two elections. The very first thing this proves to me is the conservative view points of the Republican states and their resistance to change and government involvement. I also think it would be interesting if every U.S. citizen decided to vote. So many variables play into elections, and many opposing sides are balanced out. For example: Low-income people usually tend to vote Democrat, but there is less of a voter turn -out of those types of people, as stated in the 7th paragraph. It would be interesting to see how much of the voting results would be changed if every citizen voted. Medicade expansion appears to benefit the areas that need it most. If low-income people mostly vote democrat, and the predominantly democrat states are the ones who adapted the reform, then those who need it are able to receive it. It still doesn’t help those low income families who live in a Republican state, or vote Republican, and could benefit from Medicade, but it does appear to be helping a good portion of those people. This also goes along with the point made in the 8th paragraph about those who live in the states that didn’t accept the reform are those who are less likely to qualify.
    AS I stated before, I believe that eventually all states will accept this reform. As discussed in the last paragraph of the article, it describes some of the dangers of not accepting new Medicade policies. It will result in the closing of more hospitals because they are not receiving the funding they need to stay open because the low income people are not covered by the new Medicade laws. Upon realizing this, I think many people will realize the states’ decision in accepting or denying Medicade could ultimately be a decision between life or death.

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  14. To be honest I didn’t even know what the affordable care act (Obama care) was until reading this. All I knew is people had very different view on it. My view is that the affordable care act is a good program. I believe the ACA did the right thing requiring states to expand Medicaid coverage to allow more people to qualify. The reason I believe it is right is because as America we should try to help as many people as possible. Helping is the biggest thing and providing Medicaid at no cost to families with low incomes and children is even better. I just think it is really selfish and inconsiderate that the states that need Medicaid the most with the poorest individuals cannot receive it. The reverse income affect is a really cool model, I didn’t even know it was like this. I just think that Medicaid should be available to people who need it regardless of what state they live in. -Rman

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  15. To be honest I didn’t even know what the affordable care act (Obama care) was until reading this. All I knew is people had very different view on it. My view is that the affordable care act is a good program. I believe the ACA did the right thing requiring states to expand Medicaid coverage to allow more people to qualify. The reason I believe it is right is because as America we should try to help as many people as possible. Helping is the biggest thing and providing Medicaid at no cost to families with low incomes and children is even better. I just think it is really selfish and inconsiderate that the states that need Medicaid the most with the poorest individuals cannot receive it. The reverse income affect is a really cool model, I didn’t even know it was like this. I just think that Medicaid should be available to people who need it regardless of what state they live in.

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  16. Nakisia Saddler

    In my opinion a majority of Americans are not even Giving Obama Care a chance to prove that it will work. They are so caught up into what the Republicans are saying instead of reading and investigating the pros and cons for themselves. Why is they so afraid of change? I thought most change , for instance Obama Care should be for the better. This Obama care just want to make sure that all Americans have health insurance or can afford health what is so wrong about that?

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  17. Angelique VirgleMay 4, 2015 at 6:32 PM

    In my opinion, I think that the ACA is helpful and needful for all states, no matter which party we support. Everyone that is denying the ACA is only thinking about themselves and assuming that the way they live and money they make is the same as everyone else. We, as the people of the U.S. need to start thinking and caring about others and become more concerned about the well being of others. Everyone doesn't make an abundance of money where they can afford all the things necessary for their living. People need to think about it this way, say for instance that a child gets very sick and the mother doesn't know what's wrong. She takes him to the hospital to see what's wrong but because she doesn't have health insurance, they turn her away and say that they cannot see about her child. So the mother takes her child home, and about a few days later, the sickness takes over the child's body and the child dies. Now if the hospital who turn the mother away finds out about the child dying, how do you think they will feel. No one wants "the blood" of someone else's life on their hand . Then too, it doesn't have to be a child. It could've just been a single man who doesn't have a good paying job where he can afford health insurance. Either way, everyone needs it. So by states passing the ACA, it would benefit all the low income individuals who need health insurance everywhere in the U.S.

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  18. I strongly believe that it is part of the right of all citizens of America to have health care coverage. It is an essential requirement which can save the lives of many individuals in low income families and benefit American society in general. I think that Americans should be more open minded to the Obama Care plan regardless or religion, sex, or political background because it will do more good than harm in the long run. It is only because of greed why certain individuals would not want the public to gain access to proper health care in fear that it would hurt their pockets! However, they fail to realize that it would be better for the economy if all people get access to health care because it would increase the longevity of people and there would be less prevalence of illness and unnecessary deaths in the country. It always costs more to cure something than it takes to prevent it. In many places in the world, people do not get the opportunity to be cured and treated from illnesses because of their financial status. Hence the fact that the United States is a place of new beginnings and opportunities, all individuals should have an equal opportunity for a better quality of life. The opportunity for better health shouldn't be determined by money because everyone's lives matter, whether they are rich or poor. In conclusion, the fact of the matter is that all individuals should have access to health care/insurance.

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  19. The Affordable Care Act (Obamacare), in principle appears to be the most fundamental legislation that aims to bring medicaid cover to even the lowest rungs of the American society. In the last 40 years, no legislation has come even close to transforming the US health care system as the Obamacare. The adoption of this legislation will effectively extend substantial benefits to low income households. It is indeed unfortunate, that states see this as coercion and therefore refuse to accept it. Without the expansion of this act, it will continue to cover those who are already able to afford medical care and expensive insurance premiums. If it comes into effect, this new law will have very far reaching effects. Not only will it change the way health insurance markets operate, but also will also have a significant impact on health outcomes of large populations. Political affiliations and strong leanings towards political ideologies, unfortunately blind people to the many benefits that the legislation may have for them and therefore, they oppose Obamacare wholeheartedly, condemning thousands of families all across the US to poor medical care. Another thing that is unfortunate, is that those who are the poorest, and who stand to benefit the most by Obamacare, are the ones who tend to vote for Republican candidates to create state governments that prevent its expansion.
    -NB

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  20. This is a great read. I am not for the ACA but I can understand why many people are. I personally believe it will further damage a fragile economy while piling on more debt to our 17 trillion we already have. It has caused many businesses to freeze pay, stop hiring if they are close to 50 employees, and they have began to pass it off onto the employees with higher co-pays. I Think we have a lack of personal responsibility in progressive America, and believe that our problems should be paid for by those that have worked hard. I make very little money but have found a way to pay for college for both my wife and I, pay for a house, and still have enough to save. I also want to disagree with the idea that low income states that need it the most are the ones denying the expansion. http://taxfoundation.org/blog/new-state-level-price-data-shows-smaller-state-real-income-differences.
    http://www.missourieconomy.org/indicators/cost_of_living/

    These two articles will lead to my next point if you care to take a look. I will use Mississippi as my example because they are according to this map one of the poorest states, and have not expanded medicaid. When we adjust for cost of living they actually average more money than: Arizona, Nevada, California, New Mexico, Oregon, Hawaii, and West Virginia, ALL of which have expanded their medicaid. So based on this how if they are able to have more money after paying to live, do they need this expansion more than these mentioned that have expanded? I do believe is Healthcare reform, but the ACA is not the answer.

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  21. Along with programs such as SNAP and TANF, I think Obamacare plays a significant role in helping low-income families. This program could save thousands of people’s lives. I understand that there are some problems with the Affordable Care Act such as increasing taxes, increasing insurance costs, or even requirement for enrollment. However, this act was meant for the public health and to help the poor.
    Though I was not surprised to see the relation between the states’ political party and their decision on Medicaid expansion, I still wonder why they could compare their political views to someone else’s health. Supporting one party does not mean that they have reject the other party’s proposal. I believe that the states should do research and statistically analyze to see if the people are qualified for Medicaid in order to expand it, if necessary.

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  22. Along with programs such as SNAP and TANF, I think Obamacare plays a significant role in helping low-income families. This program could save thousands of people’s lives. I understand that there are some problems with the Affordable Care Act such as increasing taxes, increasing insurance costs, or even requirement for enrollment. However, this act was meant for the public health and to help the poor.
    Though I was not surprised to see the relation between the states’ political party and their decision on Medicaid expansion, I still wonder why they could compare their political views to someone else’s health. Supporting one party does not mean that they have reject the other party’s proposal. I believe that the states should do research and statistically analyze to see if the people are qualified for Medicaid in order to expand it, if necessary.

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  23. James Lewis
    June 21, 2015
    This article outlines the politics and behind the Affordable Healthcare Act, and the most interesting correlation is between median income in states and whether that state chose to expand Medicare. I am not surprised that lower income people tend to vote democrat; therefore, vote in favor of expanded healthcare. What is shocking is that hospitals are closing in states that voted against AHA, and these states are on the lower end of median income. With a lower median income, these citizens need a way to pay for doctor visits. . To encourage the expansion, the government will offer funding to the state for the program. This is the paradox; the states that rejected expansion tend to be conservative states with lower median income.
    Also, the correlation between which party won the electoral votes and voting for the AHA is not surprising. Democrats tend to be lower income individuals, and these individuals want the medical coverage. Republicans against the program want to keep the healthcare system up to the states, but need to reconsider because they are neglecting individuals within their state.

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  24. I have kaiser for my health insurance and it is almost $500 a month deducted from my mothers' check every month. People fail to realize how expensive insurance is. If i had the choice to get on medicaid or the opportunity I would. It saves money from co payments and medicine. Even with us paying that much a month we still have high co-payments and high medicine. So, the Obama care act is good for the people who cannot afford health insurance because everyone needs a proper check up at least once a year. Maybe it would have prevented so many diseases from spreading.
    Sentoria Moss

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  25. I think Obamacare seems like a good idea. I was not surprised by what states reused to expand Medicaid though. I think that giving people access to preventative healthcare could cut down on overall healthcare costs because problems are caught earlier or even prevented. The reverse income effect is very interesting. I feel like in many cases it is the conservative, rural people need the most healthcare. Perhaps they are for subsidized healthcare but they, like blacks and Latinos, don’t turn up in the numbers needed to sway the election.

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  26. I strongly support the Obama health care plan as it gives every individual a fair chance of affording at least the minimum requirements of a health plan.It is surprising when people go against a plan which covers all the sectors not only the upper class or middle class.Of course this plan has its complexities as others.Obama care still works better as it covers the lower middle class and gives all the individuals an equal chance to afford a good health care plan.Politically speaking it is obvious that most of the votes for the democrats come from a middle or lower middle class thus support for the Obama care comes mostly from them as compared to the Republicans.There are low income families who deserve an equal chance of having the health care they deserve and Obama care gives them that chance.

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  27. I am in favor of the ACA that Obama has put in place. I think that some states should accept the Medicaid coverage to benefit from it. Low income families, along with everyone else in America, should be able to receive some kind of health services that are affordable to them. Conservative states I think are only hurting themselves by rejecting Medicaid. This is why mostly low income people vote Democrat. It is costing lives to not help those around you get the health care they need. I understand that the expansion of Medicaid will cost the federal government a huge amount of money in the long run but you cannot put a price on lives. The closing of hospitals is endangering the people of not having the proper care they need at a timely matter and can turn into a life or death situation. People are in need and without it I think all of America would suffer the consequences. People come to America for a better quality of life and with that health care coverage should be a given opportunity. With Medicaid there could be less people out in the world sickly and honestly it is much better to prevent something rather than wait until it is too late. It is all about helping those in need and if we can do that we would be a better America. Money should not define whether we should receive healthcare or not. Some are blessed to afford it and others need help which they should be. All should be in favor of ACA.

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  28. I am in favor of the ACA that Obama has put in place. I think that some states should accept the Medicaid coverage to benefit from it. Low income families, along with everyone else in America, should be able to receive some kind of health services that are affordable to them. Conservative states I think are only hurting themselves by rejecting Medicaid. This is why mostly low income people vote Democrat. It is costing lives to not help those around you get the health care they need. I understand that the expansion of Medicaid will cost the federal government a huge amount of money in the long run but you cannot put a price on lives. The closing of hospitals is endangering the people of not having the proper care they need at a timely matter and can turn into a life or death situation. People are in need and without it I think all of America would suffer the consequences. People come to America for a better quality of life and with that health care coverage should be a given opportunity. With Medicaid there could be less people out in the world sickly and honestly it is much better to prevent something rather than wait until it is too late. It is all about helping those in need and if we can do that we would be a better America. Money should not define whether we should receive healthcare or not. Some are blessed to afford it and others need help which they should be. All should be in favor of ACA.

    Lauren Bruce

    ReplyDelete

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