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The April 2014 Kaiser study on the South and Obamacare

In 2014, the South had mostly rejected Obamacare, and an April 2014 report from the Kaiser Family Foundation suggested the region could get the most out of the health-care law's marketplaces and Medicaid expansion.

The South could have benefited the most from Obamacare in April 2014

In 2014, the South had mostly rejected Obamacare, and an April 2014 report from the Kaiser Family Foundation suggested the region could get the most out of the health-care law's marketplaces and Medicaid expansion.

The report measured the effects of refusing some of Obamacare's optional programs. Many Southern state governments had rejected the Medicaid expansion in particular because they felt it expanded a struggling program and saddled states with higher health-care costs.

"It’s like putting 1,000 more people on the Titanic when you knew what was going to happen," Gov. Rick Perry said at a 2013 meeting of Republican governors.

The KFF report covered a lot of data highlighting the unique characteristics of the South. But it could be broken down into a few key takeaways:

  1. Most of the South had rejected Obamacare by refusing to take up state-run exchanges (instead leaving the task to the federal government) and the Obamacare-funded Medicaid expansion, which the US Supreme Court made optional in 2012. (More here.)
  2. The report found the South was poorer than most of the nation, which meant the region could at the time benefit the most from Obamacare programs that disproportionately benefit lower and middle classes. (More here.)
  3. Southerners were more likely to report worse health than the rest of the country — another sign that the region could have benefited the most from programs expanding access to health care in Obamacare. (More here.)
  4. Southerners were less likely to have health insurance, according to the KFF report. Since Obamacare's primary objective is to cover as many of the uninsured as possible, the South's high population of uninsured could get the most out of the health-care law. (More here.)
  5. Southerners reported the most trouble accessing affordable health care, which could have been alleviated through Obamacare by providing health insurance through Medicaid or the tax-subsidized exchanges. (More here.)
  6. Rejecting Obamacare's Medicaid expansion and state-run exchanges might have hurt minority groups more than anyone else, based on KFF's findings. (More here.)
  7. The federal government covers most of the Medicaid expansion, but Southern states would have seen the largest cost increase compared to other US regions. (More here.)

Most of the South had rejected Obamacare

By April 2014, 16 out of 50 states opted to run their own insurance marketplaces under the Affordable Care Act. Only two out of 16 Southern states (Kentucky and Maryland) decided to run their own exchanges.

Obamacare_exchange_map

Meanwhile, a majority of states around the country had decided to take on the Obamacare-funded Medicaid expansion. But just five out of 16 Southern states had expanded Medicaid by April 2014. And the ones that have expanded Medicaid were all in the northernmost part of the region.

Medicaid_map

At the same time, Medicaid was far more restrictive in the South than in the rest of the country. As of January 2014, the median Medicaid program in the South didn't cover childless adults at all.

Screen_shot_2014-04-28_at_10.04.25_am

The report found the South is poorer than most of the nation

The April 2014 Kaiser Family Foundation report found Southerners were significantly more likely to be living in poverty than their Northeastern and Midwestern counterparts.

Poverty_by_us_region

Median income in the South was also lower than the rest of the nation.

Median_income_by_region

But the unemployment rate was much lower in the South than the rest of the country.

Unemployment_rate_by_region

Southerners were more likely to report worse health

Southerners were much more likely to report fair or poor health compared to the rest of the nation, according to the Kaiser Family Foundation's April 2014 report.

Health_reports_by_region

It's perhaps unsurprising, then, that a majority of states reporting high cases of adult diabetes were in the South.

Diabetes_rates_by_state

And Southern adults were more likely to be overweight and obese than their counterparts in the rest of the country.

Obesity_rates_by_state

Southern states also reported some of the highest infant mortality rates in the nation.

Infant_mortality_rates_by_state

Southerners were less likely to have health insurance

According to the April 2014 report by the Kaiser Family Foundation, the South had the highest uninsured rates in the country.

Insurance_coverage_by_us_region

The uninsured rate varied a lot among Southern states. Texas and Florida, the two most populous in the region, had the highest share of uninsured among their peers.

Screen_shot_2014-04-28_at_10.16.10_am

The Medicaid expansion covers low-income, childless adults — a group that wasn't covered at all by the South's pre-Obamacare Medicaid programs. Most of the uninsured in the South fell into that category at the time of KFF's report.

Uninsured_in_the_south

Under Obamacare, low-income Americans who can't get Medicaid or Obamacare's tax credits fell into a coverage gap in which no public aid was available to buy health insurance. Nearly four in five uninsured Americans who fell into the coverage gap lived in the South, according to Kaiser.

Regional_distribution_of_coverage_gap

Southerners reported the most trouble accessing affordable health care

Along with the West, people in the South reported having the most trouble accessing affordable health care, according to the Kaiser Family Foundation's April 2014 analysis.

Health-care_access_by_us_region

More than one in five Southerners lived in an area with health professional shortages, meaning they didn't have enough access to doctors and other medical providers.

Screen_shot_2014-04-29_at_2.08.06_pm

Southerners were also more likely to go to the emergency room with chronic conditions. Under ideal circumstances, these conditions would have been treated on an ongoing basis in non-emergency settings by a family physician or specialist. But gaps in accessibility to health care and insurance made consistent care less likely.

Screen_shot_2014-04-28_at_10.19.31_am

The South's health-care gaps hit minorities the hardest

In the South, black Southerners reported the worst health status among racial and ethnic groups in the Kaiser Family Foundation's April 2014 report.

Southerners health by race and ethnicity

Black and Hispanic Southerners also reported the highest uninsured rates, and they tended to rely on public plans more than other groups.

Insurance_coverage_in_south_by_race_and_ethnicity

More than half of black and Hispanic adults in the South fell into the coverage gap, meaning they didn't have access to Medicaid or Obamacare's tax credits for private health insurance.

Coverage_gap_by_race_and_ethnicity

The feds cover most of the Medicaid expansion, but it would have cost the South more than other regions

The federal government, through Obamacare, pays for a majority of the Medicaid expansion. If Southern states had embraced the expansion, they would have seen the largest increase in federal dollars out of all states. They would, however, also have seen the largest increase in state costs, according to the Kaiser Family Foundation in April 2014.

Medicaid_expansion_funds_by_region

At the same time, the South already was getting a great deal out of the Medicaid program: the federal government picked up more than 60 percent of the cost in most Southern states at the time.

Share_of_federal_funding_for_medicaid

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