For those of us old enough to remember, the largest expansion of government FUNDED healthcare was the introduction of Medicare Part D. Enacted in 2003, it took effect in January 2006. As of today, only about 75% of eligible folks have signed up. This is in part because folks have other coverage (such as the VA) make a decision and, for the number of people no chronic conditions, the $1100 the spend on prescriptions is less than the $4800 they pay into Part D. Helping people make the decision, as I recall, whether or not to sign up were an army of sales people from the 33 different plans, the government, and the managed care organizations.

If you look at the sales effort for the Affordable Care Act, it has been much more low key. This is in part because, at least in Alabama, there are a number of people who consider selling ObamaCare the equivalent of selling tickets to Hell. Also, because of the long lead time, those with a vested interest (the insurance companies) have not been as aggressive as the pharmaceutical companies were.

The universal coverage piece of the Affordable Care Act is dependent on those who are poor (below 139 of poverty) obtaining Medicaid. Many of the “Red” states have balked at this provision and are not likely to “try and sell” it to the people. Someone is going to have to do it. A poll by the Joint Center for Political and Economic Studies asked citizens of several Red States (including Alabama) about the sales pitches and here is what they found:

The good news? They found:

strong support for the Medicaid expansion  provision of the Affordable Care Act as well as  for other provisions of the health care law. On  the survey’s general question about Medicaid  expansion, 62.3 percent of respondents, including  majorities in all five states and a majority of  non-Hispanic whites, supported expansion.  The survey’s detailed question on Medicaid  expansion received 53.8 percent support from  all respondents and majority support in all five  states. A majority of non-Hispanic whites did not support Medicaid expansion on the detailed  question, but a plurality did.

The bad news?

For those not wanting the expansion, the following arguments were not helpful in moving them to yes:

  • What if you heard that this would mean many low income people in your state would be left without health insurance, and your state would be giving up additional federal dollars for covering its uninsured residents?
  • If your state rejects Medicaid expansion, taxpayers in your state would be subsidizing health care in states that do  expand Medicaid coverage. Knowing this, would you still prefer to keep Medicaid as it is today, or would you prefer to expand Medicaid to cover more low income uninsured people in your state?
  • After the first three years when the federal government pays for all of the costs of Medicaid expansion, [STATE] can withdraw from the program any time it wants. Knowing this, would you still prefer to keep Medicaid as it is today, or would you prefer to expand Medicaid to cover more low income uninsured people in your state?
  • The nonpartisan Kaiser Family Foundation and the Urban League calculated that states will get $9 from Washington for Medicaid expansion for every $1 they spend on the expansion. Would knowing this make you more or less likely to support Medicaid expansion?
  • A side benefit of the Medicaid expansion is that it would create thousands of new jobs and large amounts of economic activity and new tax revenue in your state. For example, the state of Alabama estimated that the Medicaid coverage expansion would reduce the state’s uninsured population by 232,000 individuals while generating $20 billion in new economic activity and a $935 million increase in net state tax revenue. Would knowing this make you more or less likely to support Medicaid expansion?

Not asked was if those opposed would prefer all poor people to sicken and die or just those that don’t look like them.

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