For everyone who isn’t paying attention to the good news about how former President Barack Obama’s national health law, the Patient Protection and Affordable Care Act [ACA], is helping in Ohio, one million Buckeyes who didn’t have health care insurance before the ACA have it now.

Through a combination of a marketplace exchange and the expansion of Medicaid, the federal/state health insurance program for the poor under Obamacare [aka ACA], the rate of uninsured Ohioans is at its lowest level ever.

Before the rollout of the Health Insurance Marketplace in 2013, 1.3 million Ohioans or slightly more than 11 percent of the population did not have health insurance.

Buckeyes Benefit From ACA

Slightly under a quarter-million Buckeyes, 238,843 to be exact, enrolled during this year’s open enrollment for private health plans sold under the ACA, reports say. Across the nation, more than 9.2 million Americans signed up for 2017 coverage in the 39 states, according to government figures. Enrollments in Ohio and nationally are down a tad from last year, but that could be because private insurers raised their premiums without a corresponding increase in federal subsidies for qualifying enrollees. According to one report, there was a premium increase of 25 percent, on average, for benchmark 2017 Obamacare insurance plans sold on versus last year. In Ohio, that increase was lower at just 13 percent.

Another reason, one with political motivations, is that President Donald Trump reduced all outreach efforts and advertising spending in the final days of open enrollment after his inauguration on Jan. 20. Republicans have long tried to vex the ACA and its rollout in order to claim it isn’t working. Throughout his winning campaign for president last year, Donald Trump claimed the ACA was a disaster, and that he would repeal and replace it. So far, Republicans in control of congress have repeal on their schedule, but have yet to disclose a detailed plan to replace it. Some attribute the cause to 413,000 fewer people signing up for the ACA in the final two weeks of open enrollment than during the same period last year to Trump’s cut in promoting the law.

Another reason, one that buts up against GOP ideology on the ACA as a burden on the market, is an improving economy where more people have jobs that offer health insurance. The ACA was designed to address about 15 percent of the population who didn’t have access to affordable healthcare through their employer or because they had enough funds to buy coverage on their own. As a direct result of how well the ACA is working, the share of Americans without health insurance has dropped to a historic low of about 9 percent, Health and Human Services reports.

ACA Working In Michigan

In another twist that flies in the face of Republican claims of how bad the law is, reports from Michigan say unpaid bills & charity care dropped by nearly half at Michigan hospitals soon after Medicaid expanded. The Institute for Social Research at the University of Michigan reports that soon after the state government expanded Medicaid under the Affordable Care Act in spring 2014, many hospitals saw a major drop in this uncompensated care. “For decades, hospitals across Michigan have written off the cost of hundreds of millions of dollars’ worth of healthcare every year, after caring for people who didn’t have health insurance,” the study says, noting that the cost from unpaid bills and charity care weighed on the finances of institutions that served the state’s residents.

“For the 88 hospitals that have reported a full year’s worth of data from the post-expansion era–62 percent of all hospitals in Michigan–the amount dropped by about half overall. Not all of the hospitals saw such a large drop, but over 90 percent of the hospitals reporting data from 2015 saw a decline in the percent of their total expenses that came from uncompensated care,” new analysis by researchers from the U-M Institute for Healthcare Policy and Innovation, which holds the state contract to conduct a federally mandated evaluation of Healthy Michigan Plan’s impact on the state’s population, health care system and government shows.

According to the U-M study, uncompensated care includes both charity care and bad debt. “Hospitals provide charity care for patients who meet their criteria, without expecting to get paid, and account for what the care cost them.” Uncompensated care also includes bad debt, or the total amount of all uncollected bills that the hospital issues to patients that it expected to pay. “Bad debt can come from patients who have no insurance but who have incomes that the hospital deems high enough to make payment feasible,” said co-authors Thomas Buchmueller, Ph.D., and Helen Levy, Ph.D. Buchmueller and Levy said bad debt also comes from patients who have insurance “that does not cover the entire cost of their care–for instance those with high deductibles that they must pay before insurance kicks in.” The latter, they say, is often called “under-insurance”, when an insured patient owes more money than they can pay.

After years of confusion on the issue foisted by Republicans, they may be winning since 53 percent of Americans continue to disapprove of the law, according to a Gallup poll taken immediately following last falls’ presidential election. At the same time, Gallup finds that about 80 percent want to maintain the law in some form. That 80 percent approval includes about 43 percent of Americans who approve of the law as is or would make minor changes, and 37 percent who want to repeal and replace Obamacare with a new law that makes significant changes.

Kasich Finds Niche On Medicaid Expansion

Ohio’s term-limited governor, John Kasich, has found a niche in supporting Medicaid expansion. He’s now at odds with Ohio delegation Republicans, including his former driver Rep. Pat Tiberi, who want to repeal but have no replacement plan in hand. Kasich, who ran for president last year but got clobbered by the Donald, even said the ACA would be gone if he was president. Yet he’s become a darling of national media for saying what his party and its leaders want to do is a “very, very bad idea.”

The report from Michigan, and statistics from Ohio, show how valuable the ACA has been to poor unfortunates who lost their jobs or who didn’t have enough money of their own to afford the high cost of private insurance without help from Washington to make insurance affordable.