Uninsured in America: Before and After ACA

 Politics of Resentment: Texas Style

In states that have not expanded medicaid

• Many working poor applied for coverage on the exchange and were told that they were to well off to get subsidies, but too poor to afford to purchase coverage (without medicaid expansion)
• many don't use their insurance because the deductible was too high
• All were unhappy with their insurance coverage and resentful because of it
• Women's Health Services hit hardest
• Texas refused to expand female reproductive healthcare through medicaid even though the coverage by the federal government was 9 to 1.
• most people were unaware that the coverage gap was due to their states policy decisions
• government handouts were framed as a race issue
• immigrants were seen as coming across the border to work the system

Who does and does not deserve healthcare: Idaho

• did not expand medicaid.
• only available to pregnant women, children, parents of children under the age of 19, the disabled and the elderly who income qualified.
• Doctors selectively accepting patients
• take patients with better paying plans only
• restrict number of medicaid patients
• don't take medicaid or uninsured patients -at all
• major physician shortages persist in rural areas to this day- CRISIS
• May have to drive for hours to see a doctor
• Low income workers expressed anger for the poor who qualified for subsidies

Mississippi Disability

• holds last place in most measures of population health
• declined medicaid expansion- affected more than 280,000 residents
• chronic shortage of primary care providers, especially in rural areas
• of the 10 states with the largest black populations, only Maryland and Delaware expanded Medicaid!
• Mississippi, Arkansas, kentuckyt, maine, Alabama, west Virginia have the highest cluster of those receiving social security disability (due in part to lack of access to care and delayed or absent treatment for conditions which eventually become debilitating)
• this may be the only source of income they have and do not qualify for healthcare subsidies on disability
• POWRA: Welfare CAP of 5 years
• Disability rates have increased in direct proportion to the number of peoiple leaving welfare eligibility
• disability is highly stigmatized in US culture = moral virtue of work

States that have expanded medicaid

• Illinois
• many who remain uninsured are reluctant to accept government handouts for moral reasons
• Massachusetts
• no significant coverage gap in the state

When resentful, people are often confused and frustrated about the unequal patchwork of coverage and the complexity of application process