If Obamacare Fails, Blame the States
Policy + Politics

If Obamacare Fails, Blame the States

Since the president’s healthcare law took effect, health experts and economists have released a spate of reports and studies attempting to assess how Obamacare is shaping up.

And while most of the research tends to have a broad focus, a new analysis from Yale University takes a different approach by evaluating each states' individual Obamacare experience.

The study, from Yale economist Amanda Kowalski, examines how each state decided to implement the law and how those decisions have affected enrollees. 

Related: Uninsured Dropped Fastest in Battleground States

For example, the study looks at whether the states set up their own exchanges or relied upon the federal exchange. It also takes into account how well the state exchanges worked—were there technical troubles similar to Healthcare.gov? Or did the launch go off smoothly without a hitch? And then, of course, the researchers looked at whether states decided to expand their Medicaid programs.

Kowalski and her team concluded that the law impacted enrollees significantly differently, depending on their states’ answers to these questions.

For example, enrollees in states that were resistant to Obamacare-- like Alabama, Missouri, Oklahoma, Texas and Wyoming tended to be $245 worse off on an annual basis compared to enrollees in states that more warmly embraced the law. Kowalski explained in the paper that although the costs per enrollee in these states started out lower, the costs exceeded all other states by the second quarter.

This is likely explained by a high percentage of enrollees being sicker and costing more, and as Kowalski notes, Obamacare-resistant states tend to have weaker than average outreach efforts—meaning fewer young and healthy people were likely to enroll and be added to these risk pools.

Another issue that jumped out in the study was how significantly enrollees were affected by tech troubled exchanges.

Related: Millions Wasted on Broken Obamacare State Websites

Hawaii, Maryland, Massachusetts, Minnesota, Nevada and Oregon had the worst performing state exchanges—crippled by serious technical glitches. The report found that in these states, the costs per enrollee was exceptionally high--potentially because healthy people weren’t as likely to sign up and join the risk pool, as they were in well-functioning state exchanges.

Another thing the study takes into consideration is whether or not states decided to extend non-compliant ACA plans for a year. In states that allowed people to stay on these plans—Obamacare enrollees’ were $18 worse off, though the study noted that further research is needed.

Kowalski cautioned that her study only examines the first year, and that the law will continue to evolve. 

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