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These states have chosen to shut their poorest residents out of Medicaid. They have chosen to do so despite 100% federal subsidies (tapering down to the scandalously low level ofâ€¦90%) for such expanded coverage. Two border states have rejected this hard-line approach. Arkansas reached a challenging compromise with the federal government. So did Kentucky. These states displayed the nationâ€™s largest declines in their proportion of uninsured residents.

Meanwhile, the biggest southern states with large, poor, non-white populations have conspicuously demurredâ€”despite ample evidence that the Obama administration is willing to make significant compromises with conservative governors and Republican legislatures across the nation to make this work.

Why have southern states have taken such a hard line that punishes so many people? I suspect the best explanation is complicated. Political party, the regionâ€™s historic legacy of racial inequality, the limited political influence of poor people–not least the word Obama in ObamaCare–all surely play a role. Whatever the explanation, millions of the nationâ€™s poorest people are locked out of basic health coverage.

If Martin Luther King, Jr. were alive today, I am confident that he would be supporting causes such as North Carolinaâ€™s Moral Mondays movement, which is working to expand Medicaid. I wish they had more company.Governor Romney has recently announced that poverty reduction would be a major theme of his potential 2016 presidential run. He didnâ€™t earn much credibility on this subject last time around. If Romney is looking for his own â€œSista Souljah momentâ€ to confront his partyâ€™s excessively conservative base, he might start by urging Republican colleagues across the south to address this disgraceful situation.

Author: Harold Pollack


2 thoughts on “This weird-looking Medicaid expansion map would sadden Dr. King on his holiday”

  1. Quite.
    I'm not sure about cartograms. They make their overall point, but the spatial distorsion is deliberately disorienting. You can convey the same information more accessibly by coloured dots, each representing say 10,000 people, so the number and visual density is proportional to the population affected. Here's one of the rural poor in the USA.

    dot density map

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