In health care, making an effort matters

April 16, 2014, 2:38 PM UTC

By Steve Benen, Steve Benen

The Affordable Care Act has obviously become a major part of a national health care system, but as is now obvious, the implementation of the policy is hardly uniform nationwide. Some states have made a concerted effort to embrace reforms and implement the ACA as effectively as possible, while others made a deliberate effort to do nothing, regardless of consequences.

And as it turns out, those consequences matter quite a bit. Gallup reports today:

The uninsured rate among adults aged 18 and older in the states that have chosen to expand Medicaid and set up their own exchanges in the health insurance marketplace has declined significantly more this year than in the remaining states that have not done so. The uninsured rate, on average, declined 2.5 percentage points in the 21 states (plus the District of Columbia) that have implemented both of these measures, compared with a 0.8-point drop across the 29 states that have taken only one or neither of these actions.

This is important. It's not just that states that have made an effort now enjoy a lower uninsured rate, it's also that these states have done proportionately better at making progress. (Note, in the above chart, lower numbers are better.)

In other words, Americans living in states that haven't bothered to create an exchange marketplace and have rejected Medicaid expansion are worse off, and adding insult to injury, insurance conditions are getting better in those states slower than if they lived in areas where officials tried to make the system work.

Those officials who want to see "Obamacare" work effectively for the public are more likely to implement the law well, to their constituents' benefit. And at the same time, those officials who want the ACA to struggle can create their own self-fulfilling prophecy.

Gallup's analysis added:

While a majority of Americans continue to disapprove of the Affordable Care Act, also known as "Obamacare," the uninsured rate appears to be declining, as the law intended. In turn, the states (including the District of Columbia) that have implemented two of the law's core mechanisms -- Medicaid expansion and state health insurance exchanges -- are realizing a rate of decline that is substantively greater than what is found among the remaining states that have not done so. Consequently, the gap that previously existed between the two groups has now expanded.

I should note for context that Gallup's reputation for political polling has suffered in recent years and for good reason -- it's polling in the 2012 presidential race, for example, was poor. The criticism was well grounded.

But this should not necessarily raise doubts about all of Gallup's data collection. On the contrary, when it comes to measuring uninsurance rates, Gallup uses bigger sample sizes than most and many wonks consider its figures to be the most reliable of any source.