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Those who have been paying attention to facts rather than GOP rhetoric know that the Affordable Care Act (ACA), a.k.a. Obamacare, has already had a positive impact in a number of areas such as permitting parents to keep their young adult children on their existing insurance policies until they are 26, providing  affordable coverage for those with pre-existing conditions, and strengthening existing and creating new community health centers (which also, incidentally, adds jobs). The primary goal of Obamacare, however, is to  extend insurance to uninsured Americans. As the Kaiser Foundation notes, starting in 2014, it will do so in two ways:

The Affordable Care Act (ACA) includes two primary mechanisms for helping people afford health coverage. Starting in 2014, people with family incomes up to 138% of the poverty level ($31,809 for a family of four and $15,415 for a single person in 2012) will generally be eligible for the Medicaid program. And, people buying coverage on their own in new state-based health insurance exchanges will be eligible for federal tax credits to subsidize the cost of insurance. Tax credits will be calculated on a sliding scale basis for people with family income up to four times the poverty level ($92,200 for a family of four and $44,680 for a single person in 2012). …

The map below, from a new Kaiser Foundation report, shows the geographic distribution of the nonelderly Americans who stand to benefit from these twin programs:

Using the accompanying zip code based calculator provided by the Kaiser Foundation, one finds that in Poplar Bluff, Missouri 26% of the nonelderly population could benefit from these ACA programs; 20% are eligible for these programs in the Central Missouri area around Columbia. In my own relatively prosperous West St. Louis County zip code, 63011, from 8%-10% of the nonelderly population will benefit from either the Medicaid expansion or subsidized coverage available through the health care exchanges in 2014. Looks like the ACA stands to meet some serious need in much of Missouri, especially, as the map suggests, in extreme Southeastern, Northeastern and pockets in Southwestern Missouri.

Meanwhile, in the state Senate, a few die-hard anti-Obamacare zealots, like, for example, my own Senator Jane Cunningham (R-7), are standing in the way of the work that is needed to establish the insurance exchanges that the ACA mandates as the mechanism to provide low-cost, federally-regulated insurance to those who need it. They’ve stormed, raged and lied themselves blue in the face about what the ACA will do, and now they’re stalling, hoping against hope that the Supreme Court will uphold their extremist reading of the Constitution.

Bear in mind that if our intransigent lawmakers continue to stall and their trust in conservative judicial activism is not fulfilled, Missouri will not be prepared to submit a plan for an exchange by Jan. 1, 2013 – which means that the federal government will step in do the work that the state refuses to do. Given the general level of functioning that I see in Missouri governmental circles, that doesn’t seem like too much of a problem to me, but I do seem to remember that these folks are the very ones who constantly whine that the federal government can’t deal effectively with local needs.  As the News-Leader points out:

We already have a $20.8 million federal grant for the exchange. It’s not a question of money. It’s a question of political will. The Missouri House passed legislation moving the state-based exchange forward. The Missouri Senate should do the same. And Gov. Jay Nixon should be stepping out front to lead on this important issue.

Hear! Hear!