[Flash Walken]

We know that about 10 million more people have insurance coverage this year as a result of the Affordable Care Act. But until now it has been difficult to say much about who was getting that coverage — where they live, their age, their income and other such details.

Now a large set of data — from Enroll America, the group trying to sign up people for the program, and from the data firm Civis Analytics — is allowing a much clearer picture. The data shows that the law has done something rather unusual in the American economy this century: It has pushed back against inequality, essentially redistributing income — in the form of health insurance or insurance subsidies — to many of the groups that have fared poorly over the last few decades.

The biggest winners from the law include people between the ages of 18 and 34; blacks; Hispanics; and people who live in rural areas. The areas with the largest increases in the health insurance rate, for example, include rural Arkansas and Nevada; southern Texas; large swaths of New Mexico, Kentucky and West Virginia; and much of inland California and Oregon.

Each of these trends is going in the opposite direction of larger economic patterns. Young people have fared substantially worse in the job market than older people in recent years. Blacks and Hispanics have fared worse than whites and Asians. Rural areas have fallen further behind larger metropolitan areas.


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That state boundaries are so prominent in the map attests to the power of state policy in shaping health insurance conditions. The most important factor in predicting whether an American who had no insurance in 2013 signed up this year was whether the state that person lives in expanded its Medicaid program in 2014. (Just consider the contrast between Kentucky, which expanded Medicaid, and Tennessee, which did not.)

In 2012, the Supreme Court gave states the right to opt out of the expansion. In all, 26 states and the District of Columbia expanded Medicaid programs this year, and at least one more state — Pennsylvania — will expand next year. Predominantly, the states that expanded had Democratic political leadership, while those that declined were governed by Republicans, but there were exceptions in both directions.

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Despite many Republican voters’ disdain for the Affordable Care Act, parts of the country that lean the most heavily Republican (according to 2012 presidential election results) showed significantly more insurance gains than places where voters lean strongly Democratic. That partly reflects underlying rates of insurance. In liberal places, like Massachusetts and Hawaii, previous state policies had made insurance coverage much more widespread, leaving less room for improvement. But the correlation also reflects trends in wealth and poverty. Many of the poorest and most rural states in the country tend to favor Republican politicians. Of course, the fact that Republican areas showed disproportionate insurance gains does not mean that only Republicans signed up; there are many Democrats living in even the most strongly Republican regions of the country.

http://www.nytimes.com/interactive/2...abt=0002&abg=0