These Five States Arenít Lifting a Finger to Implement Obamacare

Written by Sy Mukherjee

On January 1, 2014, most major provisions of the Affordable Care Act officially went into effect throughout America. Nonetheless, five red states are doing their best to ignore the reality of Obamacare, forgoing every one of the health law’s major reforms and refusing to enforce or oversee even its most basic consumer protections, according to a new†analysis by the Commonwealth Fund.

Most states are tackling at least one of the ACA’s three major components: enforcing its market reforms and consumer protections, establishing a state-run insurance marketplace, and agreeing to its optional Medicaid expansion. Seven states have taken charge of all three. However, the researchers†write, “[a]t the other end, five states ó Alabama, Missouri, Oklahoma, Texas, and Wyoming ó declined to play a role in implementing the law’s three major components. These states will not enforce the market reforms, will have a federally facilitated marketplace where the state will play no formal role, and declined to expand Medicaid.”

These five states’ decision not to run their own marketplaces isn’t uncommon, considering that 36 states have defaulted to a federal exchange. Rejecting the Medicaid expansion is somewhat more rare, since 26 states and the District of Columbia have already opted for it and several others could still do so in 2014. But the fact that these states won’t even oversee basic consumer protections and reforms through local regulatory agencies suggests a desire to be a total dead-end when it comes to health reform.

Federal officials will have to fill in the regulatory gaps in those places. But that could become a†big hassle for consumers who are trying to enroll in new health plans. If these Americans run into problems or have complaints about the enrollment process, or believe they’re being bilked by an insurer, they would have to†contact the Centers for Medicare & Medicaid Services (CMS) rather than their state’s insurance department.

Health policy experts say that regulating the market reforms within each state is†much more efficient and a better deal for consumers. Several of these states, including Texas, have claimed they have no authority to enforce the rules since they don’t have corresponding state laws on the books ó an argument that’s been met with considerable derision by public policy experts who point out that rationale hasn’t stopped the Lone Star State from implementing plenty of other federal laws.

The study authors end by raising the very types of questions that Americans in these five states are likely to encounter.

“What level of coordination will be required between state and federal regulators to ensure that the market reforms are enforced consistently in both the inside and outside markets? Where should consumers in each state turn to raise issues or ask questions about their coverage?”†asked the researchers. “How will these changes affect critical outcomes, such as enrollment, cost, and marketplace sustainability? And, for those states that chose not to expand Medicaid, will policymakers adopt other mechanisms to provide coverage for low-income consumers or will these individuals be left without access?”

This post was originally published in ThinkProgress

Photo Credit: Governor Rick Perry of Texas via Wikimedia Commons


Ken W.
Ken W2 years ago

The GOP doesn't give a damn about the US or our people just look at what they do !!!

Mary B.
Mary B2 years ago

David F..... please don't feel sorry for any of the industrialized nations for having health care for all it's citizens.......we laugh at the likes of you who keep saying you "Had" good healthcare .......maybe YOU did and the wealthy, but MILLIONS didn't......the selfish generally are like you as I've said to you before.."I've got mine so screw the rest" (you speaking)

Robert Hamm
Robert Hamm2 years ago

Trying to insure the foremerly uninsurable is not a government scheme. Its called a compromise or a deal with the insurnace companies. The reason we dont have what we used to have David is because the insurance industry over stepped itself and got too greedy. THey have spent the last 30 years lobbying or legislating their own assured profit. Stop blaming the govenrment for what the insureance companies did with their virtual monopoly.

William Eaves
William Eaves2 years ago

The USA is weird. I just cannot understand why some nutters their are against health care. In the UK the NHS is a 'godsend'. I use that last word metaphorically BTW because as an aetheist I do not believe in stupid gods.

So in the USA it is fine to own guns and kill people but not OK to look after their health. I wonder who has to pay for the victims of Wanka B's shootings ?

Wanda Bagram
Past Member 2 years ago

Susan T. said, “4 out of these 5 red states mentioned take in more in federal subsidies than they pay in taxes - in other words, blue states like CA and NY are paying their bills.”

Um, Susan you do realize that California takes up more subsidies than the entire South Eastern region combined right? I mean California has only 12% of the entire US population but takes up 34% of the entire US Welfare budget. I recommend you research your claims before you put them out there like that trying to tell which ‘ideology is not trying to help them climb out of poverty’ since I know in your heart you ‘feel’ your claim must be true but once you do just a little bit of research you find out that it is not true.

Wanda Bagram
Past Member 2 years ago

Linda M. Good questions and I will try to provide the best answers.

"How much does the US spend on the military vs health care"
To my understanding the Agreement between the US President and Congress is that 6% of the entire DOD budget is to cover Healthcare.

"Which is more important, taking care of your own citizen's health or killing foreigners?"
Don't shoot the messenger I am not the one who makes the rules or the budgets, that is the politicians. But to answer your question a little better the US spends more money of the Federal Budget on Social Programs than it does the military, but the military is what the News Media concentrates on. Actually percentage wise the US military is the #3 highest expense but social programs are #1 and #2; i.e. the budget breakdown is 23% Medicare & Medicaid, 22% Social Security, 19% Defense Department.
So going by those numbers I have the counter question of, Who is taken better care of Citizens well beign or the military?

Duane B.
.2 years ago

Thank you for sharing.

Panchali Yapa
Panchali Yapa2 years ago


Lynn C.
Lynn C2 years ago


Mary B.
Mary B2 years ago

Wanda B..... As usual, you put down ANY success story instead of saying "that's great".....Just as much compassion for US citizens needing health care as your do for those who are shot and killed daily by guns(In the US)......and you are the example for serving in the forces?......