This map probably won’t surprise anyone here:
The Affordable Care Act (ACA) includes two primary mechanisms for helping people afford health coverage. Starting in 2014, people with family incomes up to 138% of the poverty level ($31,809 for a family of four and $15,415 for a single person in 2012) will generally be eligible for the Medicaid program. And, people buying coverage on their own in new state-based health insurance exchanges will be eligible for federal tax credits to subsidize the cost of insurance. Tax credits will be calculated on a sliding scale basis for people with family income up to four times the poverty level ($92,200 for a family of four and $44,680 for a single person in 2012). (A calculator from the Kaiser Family Foundation illustrates the assistance people would be eligible for at different income levels and ages.)
The share of the population who will benefit from new Medicaid eligibility and the new health insurance tax credit will vary substantially throughout the country. We’ve illustrated that variation by estimating the share of the population in over 2,000 geographic areas across the U.S. who had family income up to four times the poverty level in 2010 and were either uninsured or buying coverage on their own.
On average, an estimated 17% of the non-elderly population nationwide would benefit from the Medicaid expansion and tax credits. In parts of Florida, New Mexico, Texas, Louisiana, and California, 36-40% of population could benefit. In areas of Massachusetts, Hawaii, New York, and Connecticut – states that generally have high levels of employer-provided health insurance or have already implemented reforms to make insurance more accessible and affordable – 2-4% of the non-elderly could benefit from the coverage expansions in the ACA.
There’s a place to plug in your zip code at the link. My zip code comes in at 18% will benefit, which is a little above the national average.
gex
Why am I not surprised that the darker areas seem to be predominantly red areas of the country?
Napoleon
13%, which surprises me since I am in the wealthiest area code in Ohio.
Villago Delenda Est
The more rural and isolated you are, the more you will benefit from these programs.
It’s like just about everything else; the more urban you are, the more economical it is to deliver a lot of services, particularly for private sector providers, who frankly cherry pick the urban areas where their profits are highest, because the logistics are the least expensive. This is very true for things like telecommunications. Much cheaper to wire up people in densely populated areas than it is for folks in the boonies. The same economies of scale (and naturally flowing higher profits) apply to medical care. Not to mention just about everything else.
Look at the map of Oregon, for example, or Montana. The darkest colors (indicating the greatest impact of ACA) are in the most remote, sparsely populated counties of the state.
This is the way this works. The private sector is loathe to service these areas, because their ROI is very low compared to the densely populated areas. Government has to pick up the slack, to address the human needs, not the needs of profit seekers.
When the only thing that matters is profit, is money, you get these types of disparities.
kay
@Napoleon:
That’s interesting, because when I made canvassing calls for Ted Strickland, nearly everyone was telling me they wouldn’t benefit, and we were calling Democrats. The general consensus was “it’s FINE, but it won’t help me, because I have insurance”.
I was surprised my area was as high as it is, too.
People in Ohio seem to overestimate how many of us have health insurance :)
Punchy
Nobody in Colorado’s expansive ski resort region has insurance or makes any money? WTF, Colly?
Also, too. South Dakota, step ya game up.
Gin & Tonic
@Villago Delenda Est: Rural Electrification Act all over again.
Who signed that? Oh, it was that other damn s0cia1ist, FDR.
Martin
In the 6th richest city in the country, it’s 14%. Someone must have put a sponge under our trickling wealth.
We would qualify under the sliding scale if we were purchasing our own insurance (I don’t expect I’ll ever see $92K for the household, even with 18 years to go before retirement – that’d be wage growth exceeding what I’ve seen over the last 16 years at the same employer).
beltane
13% in my zip code. The number is low not because it’s an affluent area (it is not) but because Vermont already has programs in effect to help low income people get health care coverage.
deep
Mines at 7%.
Yay MassHealth!
beltane
@Punchy: The hospitality industry offers lots of low-pay, no-benefits seasonal jobs. Even the most high-end ski resorts tend to pay their snow-makers and lift operators close to minimum wage. Just because you serve the needs of rich people doesn’t mean any of their wealth will trickle down upon you.
Martin
@Punchy:
Lot of self-employed people out there, and folks buying their own insurance, so at the very least many of them are getting part of that tax credit.
Native American reservations. That’s like half the state.
Credit to Wyoming though. They’re doing a surprising amount right there for being such a deep red state. They’ve done a pretty good job of taxing their mineral wealth and using it broadly across the state. Helps too that they have a population about that of the Indianapolis Motor Speedway on race day.
Schlemizel
Its information like this that makes me want to support the teabaggers efforts to end government spending on the disadvantaged. Since the people who will benefit the most are too often the exact same morans who whine about ‘the takers’ I would feel a certain schadenfreude from seeing them drown in their own stupidity.
I guess they should be glad liberals are not built that way.
General Stuck
In the south, they don’t need much ACA. Daddy Warbucks will cover expenses, if you love jeebus enough, and vote GOP.
I see liberal horns on that map/tea party for two
Legalize
So, am I reading this correctly – folks who live in primarily rural, less affluent, more isolated areas will benefit the most? In other words, the assholes who bitch and moan the most about “government handouts,” are the lucky duckies who stand to benefit the most from said handouts – as usual.
Stupid gits.
Napoleon
@kay:
Just speculation, but I wonder if there are a dispropotionate number of people who work for themselves in my zip and if anyone who is on the individual market immediately shows up as benefiting.
Percysowner
My area was split one half was 13% and the other was 24%. My family began benefiting earlier, because I was able to keep my daughter, who has a masters degree but is working a contract job with NO benefits, on my insurance. She’s 25 so she has some leeway before she has to worry about insurance coverage thanks to the ACA. Thank you President Obabama.
kay
@Martin:
I was snickering a little at Indiana, because Mitch Daniels “solved” their uninsured problems, with his market-based, voluntary, compassionate conservative program!
If you read CATO that’s what happened. It didn’t really happen.
mistermix
Not to mention that the more rural parts of the sparsely-populated states wouldn’t even have hospitals and doctors if it weren’t for all the money poured into those areas by the feds in the form of extra Medicare reimbursements for rural hospitals.
tjmn
Mine at 13%. We would be hurting here without Tricare.
kay
@Napoleon:
The site explains how they used the numbers.
I looked at Bowling Green – college town + expensive property + good public schools- and they’re at 11%.
Villago Delenda Est
It would be interesting to also overlay the areas with heavy Union presence with this map. I suspect that those areas are in the lower percentage benefit areas, because through the Union they already have substantial health care benefits, as part of the contract.
Also, look at counties that have a heavy Federal employee presence, for example, areas with military bases. Look at Yellowstone National Park in Wyoming, a special case, to be sure, but one where the population is heavily Federal employees.
Legalize
Yikes, 22% in my zip code.
Satanicpanic
This is irrelevant to the larger point- Obamacare sucks as long as those urban people are getting coverage. If you could cut them out by requiring them to drug test, have photo ids, proof of citizenship, own property, etc. then the system would be fair.
beltane
Slightly OT, but Garry Wills has written a very good critique of the Catholic bishops’ stance on contraceptive coverage in the ACA http://www.facebook.com/l.php?u=http%3A%2F%2Fwww.nybooks.com%2Fblogs%2Fnyrblog%2F2012%2Ffeb%2F15%2Fcontraception-con-men%2F&h=vAQHr-F9NAQH6v53EbO7gncOdBhHV5y-J0dY6uwhL5AITtQ
The article starts by calling Mark Shields and EJ Dionne “pusillanimous” Catholics and only gets better from there.
Litlebritdifrnt
15% here, but I suspect that is off somewhat because of Camp Lejeune and the large amounts of military dependents here as well as civil servants covered on the Fed plan.
shortstop
We live in a transitional neighborhood straddling a pretty well-heeled Chicago neighborhood and a much poorer one. Even the wealthier part of our zip code is 14%. The rest: 26%.
Dave
It still amazes me how the GOP has been able to get a substantial amount of people to vote against their own self-interest time and time again through culture issues. You would figure at some point the economic realities would trump hating Teh Blacks and abortion. And yet…amazing and sad.
Litlebritdifrnt
Also slightly OT but the last line of Sully’s piece is a thing of beauty:
http://andrewsullivan.thedailybeast.com/2012/02/obamas-winning-the-wedge-issue-ii.html
JPL
I live north of Atlanta and my zip is divided into four areas, two are 10 percent and two are 18 percent.
flukebucket
26% in my zip code and the people here just raise hell about it and how it is soshulized medicine and has to be repealed! Repealed I say!!
Georgia. It is impossible to reason with unreasonable people.
shortstop
@Dave: Those folks are always telling us that it’s not that they blindly and viscerally vote against their economic self-interests; it’s that they’ve thoughtfully weighed their priorities and they value other things more than money. Like bashing blah folk and queers, I guess.
JPL
@flukebucket: That is high. How many of those preaching against it visit the emergency room for their primary care.
Spaghetti Lee
Lessee…lots of gray in the unionized soshulist hellholes like New York, Massachusetts, and Illinois, and not so much in the free-market-lovin’ South. Makes ya think, don’t it?
Emma
My zip code has two microdata areas. One will benefit to the tune of 18% but the other one… 31%. Of course this is South Florida.
General Stuck
The deep blue in the deep south is what scares the bejeebers out of the wingnut powers that be in those regions. Can’t have liberals coming in with their red commie peerograms, and thwarting the narrative of the left is every reason why we can’t have nice things. All the food stamps and other basic sustenance they receive from uncle blue state sam, can be explained away as coming from sugar plum fairies and the like. But getting decent health care, the rubes will get suspicious and might start asking the
rightwrong questions. And once it arrives, there will be no turning it away, so the ACA must die, now, with extreme prejudice. And buried beneath the earth’s mantle, with a headstone that reads, Deep Down, It Was A Good Idea. queue up the Robed Masters of the Universe to save the day.FlyingToaster
6% in my zip code, which by their (scroll down below the map on KFF’s page) analysis is high for Massachusetts. They predicted 2-4%.
Some of Boston is as high as 20%; however, I’d bet that their caveat of “some may be ineligible due to immigration status” is in play there.
JPL
St. Ronnie signed EMTALA which mandated emergency rooms to treat the poor. Cost of care has skyrocketed since then because we are all paying for their service. Why isn’t the right screaming about this mandate?
Villago Delenda Est
@Satanicpanic:
You left out “low melanin counts”, but that’s a given for the other dogwhistles.
Zandar
17% here in my dead red NKY NOBAMA Cincy suburbs, 13% next door in the Horse Country Exurbs.
Gin & Tonic
@beltane: Any non-Facebookish link for those of us who don’t do FB?
aimai
I don’t know. They still have a two pronged offense: one) prevent people from gaining access to health care and 2) prevent them from voting to protect their new rights under the ACA. The problem the GOP is going to have is when the new rights to health care are offered to their own already existing voting base. As long as the people who benefit are primarily non voters–as a lot of the working poor are–they don’t really care.
aimai
Villago Delenda Est
@Dave:
Dave, this phenomenon ties in with my comment on another thread about it just being too hard for some to make the connection. Much easier to simply hate “the other” than to think through the entire issue. Makes their heads hurt something fierce.
Rommie
Just wait until all these unwashed masses with ObamaCare sully the rich folk hospitals with their presence. You know the usual suspects have that angle of attack warming up in the bullpen if 2014 gets here with no changes.
Villago Delenda Est
@Gin & Tonic:
Here you go:
http://www.nybooks.com/blogs/nyrblog/2012/feb/15/contraception-con-men/
urlhix
32%, yep, 32% here in rural GA.
28 Percent
11% here in Cantor Country.
BTW – nifty graphy thingy at NYT shows some nice trending: Americans on President Obama and the Economy. The news, she is good.
gex
@Schlemizel: Hear hear. It’s one thing for them to be ungrateful. But they’re actually ANGRY about the help.
kay
@aimai:
Obamacare benefits Latinos disproportionately because Latinos are uninsured disproportionately.
I think Republicans worry about that. Look at Texas.
Rommie
And my relatively well-off part of SW Lower Michigan is 18 percent.
General Stuck
@JPL:
Yes it has, but that’s just peachy for the plutocrats, cause they can get it paid for out of the US Treasury via indigent care grant funding that is out of sight and mind, in both cost and where it came from for the average joe sixpack – as compared with the ability to have normal stable health care with primary care, and all important preventive care that is cheap or free. Someone will get blamed for causing that to happen, and it will be Barack Obama. A few will hate that fact, many others won’t.
shortstop
OT, Scotty Walker is faking illness so he doesn’t have to accompany Obama to the Master factory this afternoon. Candyass.
flukebucket
@JPL:
The emergency room IS the primary care facility around here. You can’t get a seat in there after the sun goes down. And trying to reason with these people is the most discouraging thing in the world. But I refuse to give up. These people are going to be dragged kicking and screaming into the 21st century whether they like it or not.
Cris (without an H)
29% up here in teabagging NW MT.
Yutsano
@flukebucket:
FTFY. Socialized medicine has been around for over 150 years.
shortstop
@gex: There was a really interesting piece in the NYT the other day (maybe it was discussed here) about critics of the safety net who depend on it. I was a little surprised and a lot gratified to see that some of the people quoted were looking honestly at how much they get from the government, and recognizing that there’s a disconnect between their criticism and their benefits. And there were others, like the parent of a disabled child, who thought the gubbies were doing more than his child really needed, but you can see how some of those programs are an all-or-nothing deal — you enroll and you get certain benefits; it’s not a pick-what-you-want thing.
The ones who were just hopeless were the folks claiming they didn’t need or want government help while taking assistance they had to go out of their way to get. For instance, the biggest whiner was a guy who signed his kids up for both breakfast and lunch programs at school. Who is making him do that?
Linnaeus
16% in both parts of my Seattle-area ZIP.
stuckinred
Twenty fucking four percent in Athens, GA.
Villago Delenda Est
@General Stuck:
The deserting coward actually said that the uninsured can get care from an Emergency Room.
When their condition, in all likelihood preventable, is at the “it’s an emergency!” stage. So the care that could have been much more economically prevented becomes much more expensive, and feeds the hatred of the poor and indigent because everyone else picks up the tab for the far more expensive emergency treatment.
It’s win win for shitstains like the deserting coward.
Satanicpanic
@Villago Delenda Est: If it weren’t for the PC Gestapo Real Americans could come out and say that.
Scott
Not sure if their page is working right. I punched in my own ZIP code, and they said they couldn’t even find it. Then I entered my parents’ — it came up at 100%, which seems maybe a bit unlikely.
shortstop
@stuckinred: Dood, you’re back to stuckinred, or is this a one-night-only appearance!? ;)
Triassic Sands
A few days ago, in response to an especially obtuse Winger on another blog, I ran through the state health care laws concerning pre-existing conditions. Not surprisingly, guaranteed coverage was almost exclusively located in northeastern states. Deep south states? Nope. Mountain west and southwest? Nope. Massachusetts (Romneycare), Maine, Vermont, Rhode Island, blah, blah, blah.
Of course, those states that already recognize the need for laws governing pre-existing conditions, also support it nationally.
The wingers? Not so much.
Linnaeus
@Rommie:
22% in the rural northern Michigan county where my grandmother lives. But they’ll (except for some folks like my grandmother) still vote for Republicans.
gex
@shortstop: Liebruls, of course.
rb
Six percent in a mixed blue/white collar portion of MA. Unsurprising, but still interesting to observe that even in an urban area with a lot of upper middle class in a state where care is already ‘universal,’ a nontrivial portion of the population benefits from ACA.
aimai
I had this fight over pre-existing conditions and health insurance with a pudgy, white, republican in MA before Romney care had really kicked in. He had a wife with pre-existing conditions and seemed totally unaware of how health insurance worked. I mean, he knew he and she would be denied coverage but he couldn’t understand what was wrong with that or how any health care coverage plan–Romneycare in MA or any national solution–could fix that. These people will eat shit and tell you its ice cream for quite a while.
And, conversely, they will eat ice cream (government services) and tell you that the schlub at the table next to them is shitting in the pot for doing the same thing.
aimai
waratah
25% here in rural northwest Texas.
aimai
@rb:
Yeah, rb, that was true for my part of MA too: 6 percent for one part and 11 percent for another part (don’t understand how my zip code is split this way). That surprised me and I would like to see why that is.
aimai
rikryah
this shocks me not. a whole lotta dark blue in that red part of the country.
General Stuck
@Villago Delenda Est:
Yup, and I don’t think the bean counters can even get close to what the massive societal savings will be over time, when 30 million people can have sane primary and preventative care, as opposed to the desperate kind now found in ER’s across the land. At every level, a much healthier society is a much more productive one. Only the evil do not value that future.
SpotWeld
Is there any way to get the raw data (an excel table) on this. If that could be combined with similar raw data on how red/blue a given zip is it could make for an interesting x-y plot of political leaning vs. medical benefit.
Visualize the voting against self-interest that the GOP is setting up
NobodySpecial
I would think a big thing to look at is which states are ones with low labor protections and right-to-work states, and you’ll see more need there. Oddly enough, in places where people actually make more than poverty plus level wages, ACA won’t help that much yet, thanks to the lowered subsidies. I dream of a day when those levels are changed, but it won’t happen as long as we keep voting for the worst D’s.
Linnaeus
@General Stuck:
But in such a society, there would be at least a modicum of distribution of economic and political power. And the neofeudalists don’t want that.
rb
@shortstop: you can see how some of those programs are an all-or-nothing deal—you enroll and you get certain benefits; it’s not a pick-what-you-want thing.
Yep. Tailoring it to every possible scenario would be way more expensive.
Our kid qualified for state-subsidized early intervention on only one domain. In principle, by qualifying we were eligible for myriad other services. We didn’t take advantage because some other kid needs those services, but even without that ethical calculus the time involved would have been prohibitive since we had no need.
This seems like exactly the way it should work. The added paperwork for qualifying within and monitoring each domain independently would add an enormous burden onto what is already a really heavily documented process. But that doesn’t stop the (few) people I’ve heard complaining simultaneously about the beurocracy AND how the process isn’t monitored enough!
Our share of the bill was still expensive, but manageable. We are lucky to have reasonably insurance through our employers, so this was one of the (thankfully rare) times where we were paying out of pocket. I was damn glad the program existed.
Raven
@JPL: I was at the mall in Kennesaw when I went to the conference up their two weeks back, interesting folks.
les
@JPL:
The official right isn’t screaming about it because 1) it lets them say everyone gets healthcare, we don’t need no stinking reform and 2) the ridiculous spending is going into their pockets. The rubes aren’t screaming because their masters haven’t told them to.
Robert Waldmann
Zip codes ? We don’t need no stinking zip codes. Why didn’t they do it by congressional district ? The correlation looks almost perfect with the fraction of yes votes by Congressman decreasing in the fraction of their constituents who would benefit.
shortstop
@rb: Exactly — totally understand how that works and it would make no sense to have “cafeteria” benefits in that case, even if one can sometimes decline some benefits as your family was able to do.
But as far as I know, school meal programs in most or all states are a standalone benefit; you sign up for them specifically if you qualify. Hard to see how this man who claims “I don’t need or want the government’s help” is being forced to let the big bad public sector feed his kids two of three meals a day.
Martin
FWIW, I have a friend that works for a healthcare firm that primarily operates clinics designed for Medicare/Medicaid billing. They’re expanding at an unbelievable rate – building clinics all over the damn place. A lot of that expansion came due to both PPACA and the stimulus, but also what they’re finding is that as they build out a clinic, it becomes very quickly profitable, and they can afford to build another one.
Their biggest challenge is how to build clinics, particularly in rural areas, and provide enough support to them now that medicine has become so technology driven. They want to use iPads in addition to their computerized records systems, they have X-ray machines and all of the other medical doodads. The clinics don’t get enough work to keep 2-3 full-time technical staff on site (the minimum you need for a 24/7 clinic) and the clinics are too far apart that if you try and share those resources, it might take half a day for someone to get on site. They don’t want to spend money on IT and equipment techs over doctors and nurses, and they’re struggling to find ways to make it all work. The big IT outsourcers are fucking expensive and don’t have expertise with the specific needs of medical IT (not to mention dealing with all of the health records privacy requirements).
Things seem to be headed in the right direction, but it’s going to take years more yet for it to build out, and there’s going to continue to be lots of growing pains along the way. But he’s overworked to the point of wanting to quit. He’s also incredibly frustrated that the quality of employees they have to hire is so weak. Other parts of the economy might be struggling for jobs, but he can’t find qualified people, but he can’t afford to not fill positions so he’s settling for not-great folks. I suspect much of the problem the US is facing is that the expectation for the median worker is MUCH higher than it was a generation ago, so the typical rank-and-file worker now is expected to be very much above average. That’s certainly true in my office – I need to get a hell of a lot out of a $35K worker. Lots of critical thinking and problem solving with many, sometimes dozens of variables. Multiple dedicated computer systems. Presentations to superiors. We would have paid a lot more than $35K for this level of work 20 years ago, so the pay and job classifications have not kept pace with the changes in the workplace.
Martin
@Robert Waldmann:
KFF isn’t a political entity, and that would have been done toward political aims. They’ll share their data with anyone, so give propublica a ring and ask them to reswizzle the data – it’s right up their alley. They even have a new open-source geospacial data platform that they’re sharing.
Villago Delenda Est
@Robert Waldmann:
Probably a lot more efficient to do it by Statistical Metropolitian Areas, which are after all based on counties. Congressional Districts, on the other hand, in many states, are carefully crafted to provide “safe” districts for members of both parties, which may require ignoring the SMAs and counties in order to make them “safe”.
LawyerInTheMaking
@Robert Waldmann:
I found myself asking the same question. If the DNC/Obama Campaign has ANY sense, they’ll start cutting 15-30 second spots in all competitive districts telling them to ask themselves why their congressman voted against the health and lives __% of his constituents.
LawyerInTheMaking
@Robert Waldmann:
I found myself asking the same question. If the DNC/Obama Campaign has ANY sense, they’ll start cutting 15-30 second spots in all competitive districts telling them to ask themselves why their congressman voted against the health and lives of __% of his constituents.
scav
Using ZIP level data, it’s fairly easy to kluge both oounty/county-derived (MSA) and other geographies (your pick, so long as they’re larger than ZIPs). There will be problems with edges and assumptions about splitting ZIPs and population not being evenly distributed across space (spatial interpolation is a mess) but, all the same, ZIPs are at least more multi-functional than data only available at larger geographies and benefit from shit-loads of other demographic / marketing data being available at ZIP level (census stuff is different). Oh, and ZIPs are easy to code for when you’ve got the raw data, so long as you assume they’re at the home address. There’s no additional processing to figure out the relevant geography, it’s there, already coded.
scav
@scav: ETA 1. It may be better to say areal interpolation is a mess rather than spatial interpolation — my jargon is a little rusty but I think I’ve got it right now. Areal is when you’re changing spatial bases, spatial is when you’re approximating data for places you didn’t sample based on nearby samples.
eponymous
Kay,
The 30% > in Ohio appears is likely higher than it should be. From the map, it looks like it covers Holmes County. Which I’m sure you know is where a large percentage of Amish live in Ohio. Not sure if they would take advantage of benefits afforded by ACA (given their religious beliefs and lifestyle). Being from Ohio myself I do know that the Amish have some limited exemptions when it comes to such things as paying into Social Security and other taxes (although don’t hold me to that as things may have changed since I last lived near Holmes County over 25 years ago).
David Koch
This is tooo, tooo much!
We should have listened to Hamsher and the Firebaggers and killed and bill.
More over, if we listened to Jane and killed the bill we wouldn’t have to argue whether women should save $700 by receiving free contraceptives.
RCHI
Preparing to write a pretty lengthy entry in my blog about Obamacare and what it means to the next generation. Thanks for writing this.