Study: ACA depends on state buy-in

Despite entrenched opinion that the Affordable Care Act is a costly mistake, healthcare reform is flourishing in 14 states where officials support it and deploy administrative resources to further its success, according to a Scholars Strategic Network study by Harvard University's Theda Skocpol.

The study considered "two pillars" of reform: marketplace purchases of individual health coverage and enrollment growth in state-administered Medicaid programs. Skocpol examined early 2014 state-by-state numbers complied by Charles Gaba and benchmarked them to previous Kaiser Medicaid Commission projections for Medicaid and exchange enrollments, a Scholars Strategy Network announcement said.

The study showed "major progress" is occurring in 14 states, where officials are expanding Medicaid and running exchanges. States where leaders accept all or part of reform but rely on HealthCare.gov are seeing enrollments trickle in. And across the board, enrollments are minimal where authorities refuse to expand Medicaid or promote exchange enrollment.

The 14 cooperative states include California, Colorado, Connecticut, Hawaii, Kentucky, Maryland, Massachusetts, Minnesota, New York, Nevada, Oregon, Rhode Island, Vermont and Washington. These states on average have achieved 42.9 percent of projected Medicaid enrollments and 37.2 percent of projected first-year exchange enrollments.

California, Connecticut, Kentucky, New York and Washington, for example, have enrolled more than 436,000 people, which is more enrollees than the federal exchange has signed up, FierceHealthPayer previously reported.

But a completely different picture of ACA progress emerges elsewhere: Only about 14,000 Texans enrolled through the federal exchange as of November, even though Texas has the highest percentage of uninsured residents in the nation, according to the Huffington Post. Governor Rick Perry (R-Texas) called healthcare reform "a criminal act," the article noted.

The Scholars Strategy Network study brief acknowledges that "quiet cooperation by lower-level administrators is happening in a number of officially non-cooperative states." And state-specific enrollment totals are likely to change as the federal government issues additional reports. Yet overall, Skocpol found "where good faith is present, the law is working well so far."

For more:
- here's the Huffington Post article
- read the Scholars Strategy Network announcement and study brief (.pdf)

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