The Best Way to See That Affordable Care is Moving Ahead - Look at States Really Trying

Theda Skocpol, Harvard University

Opponents have already pronounced Affordable Care a failure, while the national media exaggerates every glitch and tracks the story as a DC political horse race. But America's fifty states are where the real action is. Enrollments are adding up quickly in cooperative states, and lagging where top officials are engaged in obstruction or delay. Where good faith is present, the law is working well so far.

Affordable Care's two pillars of expanded health insurance coverage are purchases of private health insurance plans on exchange "marketplaces" designed for each state, plus added enrollments in Medicaid programs administered by the states. To see where things stand at the start of 2014, SSN Director Theda Skocpol worked with preliminary state-by-state numbers compiled by Charles Gaba (aka Brainwrap), and benchmarked them to projections for Medicaid and exchange enrollments prepared some time ago by neutral experts. The results summarized in her new brief are striking and show that health reform implementation is unfolding very differently in various groups of states.

The picture for various groups of states is sure to shift in coming weeks and months, but at this early stage it is apparent that Affordable Care is doing best in the states that are really trying to carry it through. The fully supportive states that are running their own exchanges as the law envisaged are California, Colorado, Connecticut, Hawaii, Kentucky, Maryland, Massachusetts, Minnesota, New York, Nevada, Oregon, Rhode Island, Vermont, and Washington.

In short, America's new health reform can work, but it depends greatly on the capacities of the various states to administer challenging reforms – and even more on the willingness of state-level officials to pitch in to shape reform to local needs, as the original legislation intended.


January 2014