A Group of People the Size of Hawaii Just Got Health Care (Thanks, Obama)

Obamacare's website has been a loud failure. Its Medicaid expansion has been a quiet success.

Today, almost 1.5 million more people are signed up for health insurance than a month ago. That's roughly the population of, say, Hawaii or Philadelphia.

You can thank the much-maligned Obamacare.

Its still-buggy website has justifiably gotten the most attention—the law won't work if Healthcare.gov doesn't—but Obamacare is more than that. It doesn't just reform our individual insurance system by regulating and subsidizing it, so everyone can get coverage, regardless of preexisting condition. It also expands our government system by opening Medicaid up to people making 138 percent of the federal poverty line ($15,850 for singles and $21,400 for couples). And that's been working even when the website hasn't.

At least, it's worked when states have let it work. See, states aren't required to accept the Medicaid expansion. They can turn down the free money if they want—and most states with Republican governors have. (And it is pretty much free: the federal government will cover 100 percent of the costs the first decade, and 90 percent thereafter). The result is a bifurcated system where people too poor to qualify for exchange subsidies can get Medicaid in some states, but not others.

As you'd expect, Medicaid enrollment has surged in states that accepted the Obamacare expansion compared to ones that didn't. But as you might not expect, enrollment has still been growing in states that didn't. People who have always been eligible for Medicaid are finally signing up, because Obamacare's launch has raised awareness about health insurance—partly by design. In Arkansas, for example, they've been sending out letters to people on food stamps telling them that they might qualify for Medicaid too. In other states, they're making it easier to sign up online. The result, as you can see in the table below from the Center for Medicare and Medicaid Services (CMS), has been 1.5 million more people signed up for Medicaid in October alone. Applications were up 15.5 percent compared to their average from July through September in states that expanded Medicaid, and up 4.1 percent in states that didn't.

And it could have been even more. Remember, part of the administration's plan for getting more people signed up for Medicaid was to make it easier to do so online. That hasn't exactly happened yet. As Sarah Kliff reports, Healthcare.gov still has problems transferring data, so people shopping on the exchange don't always know if they qualify for Medicaid instead. Once that's fixed, enrollment could speed up even more.

You don't hear much about the millions of people who didn't have health insurance before and have Medicaid now. They don't have as much of a voice as middle-class people who are maybe losing their old plans or old doctors. But the 13 million more people the CBO expects Medicaid will cover are, to paraphrase Joe Biden, a big deal. And it should be 18 million people, if Republican governors would start caring about their people more than politics.

That'd be something.

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Matthew O'Brien

Matthew O'Brien is a former senior associate editor at The Atlantic.

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