How successful you think Obamacare is might depend on the state in which you live. In states controlled by Democrats, more than twice the percentage of eligible people are enrolled in Affordable Care Act (ACA) insurance programs than in states controlled by Republicans, according to a Kaiser Family Foundation study reported in the National Journal.

States under Democratic control have 12.5% of their residents enrolled in ACA plans. In Republican-controlled states, only 5.7% of residents are enrolled. In states with divided control, 8.2% of residents are enrolled. Eight of the 10 states with the lowest percentage of residents enrolled in ACA coverage are controlled by Republicans or have divided control. Only one of the 10 states with the highest percentage of residents enrolled, Michigan, is controlled by Republicans.

In addition, those from a given state are far more likely to be enrolled if their state runs its own insurance exchange. The state with the highest percentage of its residents enrolled is Vermont, with 33.4%. Other states with high enrollment include Connecticut (16.7%), California (15.2%), New York (12.4%) and Kentucky (11%).

Massachusetts is the state with the lowest percentage of enrollees, at 2.1%, but its exchange website had problems early on, and most of its residents are covered under an ACA-type system already. Most of their enrollees will be moved to the new exchange automatically.

Texas has the most uninsured residents of any state. Twenty-six percent of Texans do not have health insurance. Despite this figure, the state’s Republican-controlled government did not opt to start its own insurance exchange. Only 3.8 percent of its residents have enrolled in ACA plans.

Part of the ACA expanded Medicaid coverage for those in poverty, but a 2012 Supreme Court decision allowed states to decide whether to accept the expanded coverage. Many states ruled by Republicans declined the expansion, leaving their poorest residents without health coverage. Ironically, those just above the poverty line will be able to get coverage, with federal subsidies.

One anomaly in the KFF report is North Carolina. That state’s Republican government did not set up an exchange and rejected Medicaid expansion. However, 10% of Tar Heel State residents have enrolled in ACA plans. 

-Steve Straehley

To Learn More:

Where Obamacare Is Succeeding… and Where It’s Falling Short (by Sophie Novack and Stephanie Stamm, National Journal)

Rejecting Expansion of Medicaid, Republican Governors Prevent Insurance for “Poorest of the Poor” (by Matt Bewig, AllGov)