In it, but not of it. TPM DC
The difference between the top and the bottom groups tells the whole story. Those states, like California and New York, that have fully bought into the ACA have performed exceedingly well in enrolling their citizens. They're already 43 percent of their way toward their projected Medicaid enrollment, as calculated by Skocpol, and 37 percent of the way there on private coverage.
But as involvement goes down, so does enrollment. Those states, like Florida and Texas, that decided to opt out completely have only enrolled 1.5 percent of their potential Medicaid population if they had expanded the program as originally planned. By leaving their citizens to deal with problem-plagued HealthCare.gov, private enrollment is struggling, too: Only 5.6 percent toward the mark.
That means that thousands in those "Just Say No" states are going without coverage because their state leaders stubbornly refused to participate in any way, shape or form in Obamacare.
"You go back to how the law was designed, for better or worse, it gave states a lot of responsibility," Skocpol told TPM. "The states that have actually done things the way the law envisaged are the ones that are, at this early stage, doing the most toward those goals."
"But the 'Just Say No' states are putting all their lower income residents at risk," she continued, "not just by refusing to expand Medicaid but also, in many cases, by failing to help people get subsidized private coverage through the exchange."
A few things to keep in mind. First, these are aggregate numbers. Some "Full-Go" states like California and Kentucky have had excellent Obamacare experiences so far, but others, like Hawaii and Oregon, have struggled mightily. Second, the "Just Say No" states have had their private coverage enrollment slowed thus far by the failures of the federal government's HealthCare.gov website.
Lastly, it's likely that the numbers, at least for private enrollment, will narrow before the end of open enrollment in March. The data that Skocpol used included more recent enrollment figures for state marketplaces, but nothing more recent than Nov. 30 for the states using HealthCare.gov. The Obama administration has said that about 975,000 enrolled nationwide through the federal site in December.
But the underlying narrative will likely persist, especially if states continue to refuse the Medicaid expansion. Those that bought into the law will go a long way toward covering their uninsured; those that haven't will continue to leave a major portion of their uninsured without coverage.