At the end of August, the US Census released a series of maps of the United States that are incredibly important for the future of health reform. Two are particularly noteworthy
The first map details by county level the % of uninsured adults living at or below 138% of the federal poverty level (FPL). The second map details by county the % of uninsured adults living at or below 400% FPL.
Why are these maps so important? The first map is significant because it highlights the areas that could most benefit from Medicaid expansion under the Affordable Care Act, which loosened eligibility criteria for Medicaid to those living at or under 138% of the FPL. The second map illustrates the areas that could most benefit from insurance premium subsidies on the state-based insurance exchanges.
You’ll notice a pattern with both of these maps, in that areas in the Northeast and the Midwest have lower uninsurance rates than the South and West. There are several reasons for this: 1) the stronger role of unions in the Northeast and Midwest that traditionally came with better health benefits, 2) higher per capita incomes, particularly in the Northeast which makes insurance more affordable and 3) many of the states in the Northeast already had looser Medicaid eligibility criteria to cover more of their residents.
But the maps also highlight where the Affordable Care Act has the potential for the greatest impact, and where the refusal of some states to expand Medicaid is problematic – with Texas and Florida as the prime examples. The maps clearly show where the White House has to concentrate its efforts to advertise and implement the Affordable Care Act. Unfortunately, many of those same areas are controlled by governors and legislatures that are hostile to the health reform law.