Obamacare isn’t collapsing, but guess where it’s struggling

A report out this week shows once again that despite what Republicans have claimed for months, the Affordable Care Act isn’t in a death spiral. It’s not collapsing. It’s not imploding. In fact, according to the Kaiser Foundation, Obamacare is stabilizing. Insurers earned more revenue per person on the exchanges last quarter than ever. Insurers are set to make profits on those exchanges in 2017 across the country.

But not all of the country. In some places, Obamacare has legitimately struggled, with insurers fleeing and leaving consumers with little or nothing to choose from on the ACA exchanges.

Those places have something in common, however: Almost all of them are in Republican states.

Let’s dig into Kaiser’s numbers a little more. According to the Foundation’s interactive map, in the 974 U.S. counties with only one insurer, only 23 are in states in which Democrats control the legislature. (Some states, like North Carolina and Illinois, have a governor who belongs to one party and legislature controlled by the other. In North Carolina, Republicans control the agenda. In Illinois, the Democrats do.)

The takeaway: In Republican-controlled states, where lawmakers have railed against the ACA and refused to expand Medicaid, consumers are largely facing fewer insurance options. In Democratic-controlled states, lawmakers have expanded Medicaid and worked to make Obamacare healthy. And it is, in those states.

It’s not all about the lawmakers, however. Red states also tend to have the poorest and sickest populations, which costs insurers more and causes them to leave. But that doesn’t absolve Republicans of blame; it’s why they should have worked to strengthen the Obamacare exchanges.

More Republicans are proposing that the U.S. Senate might be better off doing just that – working with Democrats to fix Obamacare’s urgent issues, including resolving cost-sharing payments that will bring insurers back to the exchanges that need them most. Perhaps then Republicans can return later to remaking the health care system into something that better fits their principles.

Or, they could just continue to do what they did this week: propose health care bills that Americans don’t want, that hurt constituents, that threaten the sick and poor – just to say they “fixed” a health care system they’ve tried so hard to break.

This story was originally published July 14, 2017 at 2:47 PM with the headline "Obamacare isn’t collapsing, but guess where it’s struggling."