What you below is a map of Obamacare. It shows how much the uninsured rate has dropped in each state since the health reform law's insurance expansion went into effect.
We used Gallup data from this summer to build it. And what it shows is huge variation in how well Obamacare is working from state to state.
The variation between states is huge. The dark purple Northeast and West Coast for example, have seen some of the biggest declines in their uninsured rates. These are generally states that decided to participate in the health law's Medicaid expansion.
Obamacare looks really different in the South, where uninsured rates have dropped much more slowly. But even in those places, the decline is still pretty significant. Georgia, for example, has seen a 28.5 percent decline in its uninsured rate. And then there's Wyoming — the one state that has seen an increase in its uninsured rate, almost an accomplishment in the wake of a massive insurance expansion.
Even in neighboring states, the differences can be stark. In Washington, for example, the uninsured rate has fallen 62 percent. In neighboring Idaho, there was an 18.6 percent drop.
This map makes things abundantly clear: There are, right now, 50 different states of Obamacare. And that wasn't what the law's drafters intended at all.
Obamacare's architects didn't want the map to look like this
One of the biggest things that divides states with faster declines from those with slower changes — the difference between the light and dark purple states — is whether they decided to expand Medicaid.
Twelve of the 13 states in the two darkest shades of purple above are those that decided to use the health law to expand Medicaid to cover all residents below 133 percent of the federal poverty line (about $15,300 for an individual or $31,500 for a family of four).
Three of the four states with the slowest gains in insurance didn't expand Medicaid (the fourth is Delaware, which we'll talk about more in a bit).
Obamacare's architects never expected there would be so much variation among states. The law initially required all states to expand their Medicaid programs. But the Supreme Court found that provision to be unconstitutional in a 2011 decision, and left the decision of whether to expand to the states.
Expanding Medicaid matters a lot for how well Obamacare works
The 10 states with the fastest declines in their uninsured rates all expanded Medicaid. The fastest drop happened in Rhode Island, where uninsured rates fell 79.9 percent between 2013 and 2015.
At the other end of the spectrum, nine of the 10 states that had the smallest decline in their uninsured rate (or, in Wyoming's case, the rate increase) did not expand Medicaid.
It's not exactly hard to understand what's going on here: States that decided to make the health law's benefits more available are getting more people covered. And those that have opposed the Medicaid expansion aren't seeing nearly as much change.
Something is going very right in South Dakota — and very wrong in Delaware and Wyoming
There are certainly exceptions to these rules — and three states in particular stand out against the general patterns.
South Dakota has seen a really significant decline in its uninsured rate, which has fallen 49 percent between 2013 and 2015. That's the 11th fastest drop in the country — and it's happened without expanding Medicaid.
South Dakota is a bit surprising: The state doesn't want much to do with Obamacare. Along with rejecting the Medicaid expansion, it's also declined to build a state marketplace, relying instead on the federal Healthcare.gov. Still, the state has made a really big dent in its uninsured numbers.
On the other side of the spectrum is Delaware — a state that did expand Medicaid but only had its uninsured rate decline a tiny 5.7 percent. A lot of this, however, probably has to do with the fact that Delaware already had really robust Medicaid programs before Obamacare. It was only one of a handful of states, for example, that would cover single adults in the program. (Prior to Obamacare, most state programs would only cover mothers, children, and the sick.)
Then there is Wyoming, where the uninsured rate increased 9.6 percent as Obamacare took effect. This could have something to do with the cost of health care in Wyoming. The state has some of the highest Obamacare premiums in the country. Most states' monthly average premiums hover between $200 and $250. In Wyoming they're $426.
Still, there are other places with higher premiums (Alaska, for example, averages $719 monthly premiums, likely due to the difficulty of delivering health care in remote places). So Wyoming remains a bit of a mystery, among an otherwise national decline in the ranks of the uninsured.
