#NerdScreen: The Supreme Court, ObamaCare and 2016

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The fight over the Affordable Care Act goes on. This week the Supreme Court heard arguments about the legality health insurance subsidies for some low- and middle-income Americans participating in the ACA. More than 7 million people could be affected.

But whether you love or hate the law that’s become known as Obamacare, state-level data from Gallup show that the law has been successful when it comes to getting more Americans health insurance coverage. Since the ACA’s implementation the number of uninsured people has dropped in nearly every state across the country over the past year.

Nerdscreen Graphic ACA
Thomas, Shawna (206081602) / NBC News

Some states show much bigger drops than others and two states stand out in particular: Kentucky and Arkansas. Both saw double-digit drops in the percentage of uninsured – 10.6 and 11.1 percentage points respectively. Nationally the percentage of uninsured dropped by 3.5 points.

What drove those big drops? The two states shared some important commonalities. They are both deep red states with high poverty rates, but they were also both run by Democratic governors in 2014. They both chose to take a role in setting up their own insurance exchanges. And they both chose to expand Medicaid.

In fact, the main takeaway from these insurance numbers is they reveal power of state government, even when it comes to implementing federal laws. Of the 10 states that saw the biggest drops in the uninsured, nine of them were led by Democratic governors in 2014.

That’s not meant as a slight to Republicans, it’s a question of priorities. States led by Democrats were more likely to take a role in building their own health exchanges and expand Medicaid – nearly all of them did. And that had a lot to do with the drop in the percentage of uninsured in those places.

That also has a lot to do with the position these states are in with the coming Supreme Court ruling. The Court is determining whether those enrolled in the insurance exchange run by the federal government are eligible for the subsidies in the Affordable Care Act.

People enrolled in the 13 states with state-run exchanges, such as Kentucky, would not be affected by the ruling. Those enrolled in the 10 states where the state takes a role in running the exchanges, such as Arkansas, could theoretically take over the exchange. But in the other 27 states the uninsured rates would likely rise if the Court rules against subsidies as many people could no longer afford coverage and would be exempt from having to purchase it.

That could potentially have a big impact on the 2016 presidential race. Look at this map of the exchanges by state:

State Health Care Exchange Map
NBC News/American Communities Project

There are some noteworthy states – in terms of the electoral map – that have federal exchanges that would be heavily impacted by the loss of insurance subsidies, including Florida, Ohio, Wisconsin and Pennsylvania.

If these state numbers begin to show a jump in uninsured, particularly in those states, as the presidential campaign gets underway, health insurance and the Affordable Care Act, may be front and center in yet another national election.

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