A divided nation on providing health care

     Probably no other area of policy divides the United States more than the attempt to provide health care to citizens of different states.  The chart above from the Health Reform Monitoring Survey shows the division among states on just one of the parts of the Affordable Health Care Act---the expansion of Medicaid.  The six percentage overall difference is made even more dramatic when you examine the difference from the state with the highest percentage of uninsured with the state with the lowest rate.  Texas has the highest rate of uninsured with 27% of the population uninsured and Massachusetts (RomneyCare) has the lowest at 4.9%.  Not surprisingly the states most unlikely to have expanded Medicaid are those with conservative governments and the highest percentage of uninsured.  Maryland is in the middle of the pack of states for uninsured at 12.9% with Baltimore City and the Eastern Shore counties driving the rate higher.  Not surprisingly income levels in the different jurisdictions were the main driver of how many persons were uninsured.
      Having our health care system an employer based system will always have this reality of who is uninsured.  As I have blogged before the greatest accomplishment of the Affordable Health Care Act was the small step to create an alternative to employer based health care insurance.  The poor roll out and the challenges of developing the alternative will continue to require refinements but it provides a platform to move toward a publicly provided option for health care coverage.  The next step in that process is to create the public option that was not provided in the AHCA.   In some ways having some time to develop and refine the platform before rolling out a public option may not have been a bad thing.