health insurance marketplace

As we creep ever closer to the day that 48,600,000 uninsured Americans have been waiting so long for… October first. The day the national insurance exchanges will open. The day that Teapuglicans have fought so tirelessly to prevent. It is time we were reminded of just how ruthlessly stupid our state leaders are. Perhaps, that isn’t fair. Maybe they are not stupid, just uninformed. Or perhaps, they are betting we are.

Arkansas, DC, Kentucky, Maryland and West Virginia are expanding Medicaid to cover all of their citizens under 65 who make 133% of the poverty line or below. This graph shows the amount of Federal dollars going into each state, less the state's share to expand Medicaid, plus the premium subsidies for those up to 400% of the poverty line, the Federal part of cost sharing and the amount each state is expected to save on indigent care (all figures are estimates, of course).
Arkansas, DC, Kentucky, Maryland and West Virginia are expanding Medicaid to cover all of their citizens under 65 who make 133% of the poverty line or below. This graph shows the amount of Federal dollars going into each state, less the state’s share to expand Medicaid, plus the premium subsidies for those up to 400% of the poverty line, the Federal part of cost sharing and the amount each state is expected to save on indigent care (all figures are estimates, of course).

To those in Arkansas, DC, Kentucky, Maryland and West Virginia who are expanding Medicaid so health insurance is within reach of every one of your citizens, congratulations. Your state government works. You will benefit not only with healthier neighbors, but because of Obamacare, your states will receive an estimated total 45 billion dollars over the next five years in new and repurposed Federal dollars and state savings. That is going to create a lot of good jobs we desperately need.

The Center for American Progress suggests a multiplier of 3.8 jobs per $100,000 in Federal spending per year (not just salaries, but assumes that local salaries will be spent at local stores creating more jobs). Using that formula on on our Medicaid expansion states, that worked out to 342,836 new jobs. Even if you discount the multiplier, that is a lot of jobs.

Could have been Obamacare impact -not states
This is a “what if” of sorts showing the amount each Southern state not currently planning to expand Medicaid would get if they did, while including the premium subsides, cost sharing and indigent care savings that they will get no matter what.

For the rest of us in the South – those living in Alabama, Georgia, Florida, Louisiana, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas and Virginia that are not expanding Medicaid, at least not so far, the cost in lost federal dollars will be over $200 billion (not to the wing nuts keeping score: yes, we subtracted the amount it would cost states to expand Medicaid to include more than just pregnant teenagers – click here for those tables).

$200 billion would have created 1,572,956 jobs that will never be. Jobs with good incomes that would have been spent on houses, cars, and stuff. that drives the economy – both the private and public sector. Income that would have been taxed that could have paid for schools, first responders and bridges. What fools we are to elect the people who made sure we wouldn’t have these jobs –  Alabama: 76,228, Florida: 319,626, Georgia: 149,515, Louisiana: 87,818, Mississippi: 54,781, Missouri: 94,597, NC: 165,315, Oklahoma: 40,158, SC: 69,563, Tennessee: 112,518, Texas: 335,206, and Virginia: 67,632 – all jobs that will never be. Makes you want to puke, doesn’t it?

Projected Obamacare Impact
Estimated economic impact of Obamacare in the Southern states not planning to expand Medicaid.
Obamacare what will be jobs
Estimated jobs created by Obamacare in the Southern states not planning to expand Medicaid.

That’s the hateful part of what our leaders have done. Now for the rest of the story: no matter what Robert Bentley, Nathan Deal, Bobby Jindal, Phil Bryant, Pat McCrory, Mary Fallin, Nikki Haley, Bill Haslam, Rick Perry, Bob McDonnell (Rick Scott and Jay Nixon support expanding Medicaid, but their legislatures have, so far, failed to fund it – click here for a table showing the status of potential expansion by state) do, there are plenty of good things that will happen anyway. Topping any industrial job expansion since World War II, the Affordable Care Act (ACT), aka: Obamacare, even without expanding Medicaid, will create an estimated 810,836 jobs in these Southern states – good paying jobs. Jobs that make people happy.

If you are on Medicare, or if you or your spouse are employed and have employer-provided insurance, nothing will change for you on October first. The insurance exchanges are for small businesses, the self-employed and people who currently do not have insurance because they cannot afford it or are prevented from having health insurance because of a preexisting condition. If you are employed and work full-time or part-time, but your employer does not provide insurance, expect your employer to let you know your options.

If you are self-employed and paying way more than someone who works for a conglomerate does, you are going to love it (full disclosure: I’m self-employed, used the calculator at the Kaiser Family Foundation and Obamacare will save my family about $18,000 a year – without one cent of Federal premium subsidy – simply because I’m no longer discriminated against for not working for a conglomerate or my age).

If you have a preexisting condition, you are going to love it; if you work part time, or not at all, you are going to love it; and if you are within 400% of the poverty line as most are who live in the South, you are going to love it – even if you are young and healthy (contrary to the doom and gloomers, there are affordable policies with higher deductibles for healthy young people).

If you don’t have insurance, by law, you have to get it next year. Beginning October first, the place to shop for it is HealthCare.gov – the health insurance marketplace.

One note of caution: there may be some computer glitches and other problems (including those caused by a temporary government shutdown) – October first is just the official opening of the health insurance exchanges and there will still be about 91 shopping days until the new year. You’ll have news people covering it just like they do hurricanes when the cable TV stars find a damaged filling station sign and a puddle to stand in. The fact of the matter is that the Obama administration expected that each state would want all the money that was going to come their way for building the state marketplaces and the systems. More millions that would have been good jobs in your state were rejected – go figure.

For those of you who are under 65, unemployed or working for minimum wage and living in the states that are not expanding Medicaid, there is still the emergency room. Just tell the person at the desk that your state leaders are so stupid they want you to be there.

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Editors Note: The source of all of the charts created for this story was the Urban Institute. Download it, its great reading. However the good folks at Urban.org have nothing to do with any mistake I might have made interpreting this stuff. The feature image is by DonkeyHotey from his flckr photostream and used under a creative commons license.
Lee Leslie

Lee Leslie

I’m just a plateaued-out plain person with too much time on his hands fighting the never ending lingual battle with windmills for truth, justice and the American way or something like that. Here are some reader comments on my writing: “Enough with the cynicism. One doesn’t have to be Pollyanna to reject the sky is falling fatalism of Lee Leslie’s posts.” “You moron.” “Again, another example of your simple-minded, scare-mongering, label-baiting method of argumentation that supports the angry left’s position.” “Ah, Lee, you traffic in the most predictable, hackneyed leftist rhetoric that brought us to the current state of political leadership.” “You negative SOB! You destroyed all my hope, aspiration, desperation, even.” “Don’t you LIBERALS realize what this COMMIE is talking about is SOCIALISM?!?!?!” “Thank you for wonderful nasty artful toxic antidote to this stupidity in the name of individual rights.” “I trust you meant “bastard” in the truest father-less sense of the word.” “That’s the first time I ran out of breath just from reading!” “You helped me hold my head a little higher today.” “Makes me cry every time I read it.” “Thanks for the article. I needed something to make me laugh this mourning.” “If it weren’t so sad I would laugh.” "... the man who for fun and personal growth (not to mention rage assuagion) can skin a whale of bullshit and rack all the meat (and rot) in the larder replete with charts and graphs and a kindness..."“Amen, brother.”