State implementation of the Patient Protection and Affordable Care Act has been uneven, at best. And while most states are playing along with the federal law, a study by the Commonwealth Fund that dropped late last week reveals some pretty stark differences at the state level.
The study breaks PPACA's blueprint for expanded coverage into three broad categories, or what they call mechanisms: market reform implementation, establishment of exchanges and Medicaid expansion. And only a handful of states still aren't playing ball — steadfastly refusing to implement any of the trio of reforms — and letting the feds run the marketplaces in their states.
The holdouts, in alphabetical order:
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(AP Photo/Butch Dill)
Alabama
The Cotton State, run by a governor who also happens to be a doctor, not only refuses to implement any part of PPACA, they actually passed a constitutional amendment outlawing both the individual and employer mandates. A majority of voters – nearly 60 percent – backed the amendment at the polls.
Incidentally, Alabama boasts an uninsured rate of 15.4 percent, right in line with the national figure of 15 percent. And it's probably also worth mentioning that its one of the least healthiest states in the union, based on factors such as high obesity and smoking rates, as well as a shortage of dentists.
(AP Photo/Charlie Riedel)
Missouri
As I've written about before, Republicans in my home state have led the charge in fighting PPACA from day one, despite taking a federal planning grant for early work on a state exchange that went nowhere. Since then, the legislature's been one of the more active ones in the country, passing three state laws essentially aimed at undermining PPACA in the Show-Me State: barring the mandates, outlawing the opening of an exchange without legislative and the establishment of an interstate compact law.
For the record, Missouri has an uninsured rate of around 14 percent.
(AP Photo/Sue Ogrocki)
Oklahoma
Sooner State Gov. Mary Fallin was for it before she was against it. After accepting more than $50 million in federal funds to set up an exchange, Fallin caved to lawmakers and turned it down.
The state then went on to pass a constitutional amendment banning the mandates, while also joining Missouri and five other states in passing an interstate compact law.
While boasting an uninsured rate of 18 percent, Oklahoma is also near the bottom of the healthiest state ranking, clocking in at No. 44.
(AP Photo/Justin Hayworth, File)
Texas
I'm thinking that rose in Texas is yellow simply because it doesn't have health insurance – not unlike nearly a quarter of its residents. Not only does Texas infamously have the highest uninsured rate in the country, it's a group that also includes the highest rate of uninsured children, as well.
I bring these figures up only because Gov. Rick Perry, despite his love of vaccines, made the most headlines of any governor when he refused to expand Medicaid right after the Supreme Court told him he could – but maybe he was just the first when he declared his state could, "deliver health care more efficiently, more effectively and cheaper than the federal government can."
Texas was also part of the lawsuit challenging PPACA's constitutionality.
(AP Photo/Matthew Brown)
Wyoming
Finally, there's the home of Jackson Hole and so many Cheney family get-togethers. The Cowboy State also refused to set up their own exchange while also passing a constitutional amendment barring the mandates.
The uninsured rate is around 17 percent.
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