This weird-looking Medicaid expansion map would sadden Dr. King on his holiday

(This column is cross-posted at the Huffington Post.)

I wonder what Dr. King would think about the current health reform debate. OK I don’t really wonder. Here, for example, are his comments, apparently made here in Chicago:

Of all the forms of inequality, injustice in health care is the most shocking and inhumane.

Martin Luther King supported health care as a human right. He also knew how far we had to go as a nation in making that right a reality.

King was the energizing force behind the Southern Christian Leadership Conference (SCLC). I suspect he would be ashamed but unsurprised to see his home region so resistant to the basic expansion of health insurance coverage to Americans with incomes below the poverty line. To some extent, the extent of southern resistance is obscured by maps such as the one below, that display which states have rejected the Medicaid expansio­­­n around the country:

Screen Shot 2015-01-19 at 3.13.50 PMMany of the shaded states such as Wyoming and Montana are huge but sparsely populated. Others such as Wisconsin have small populations left uncovered for other reasons.

Harvard post-doctoral researcher Laura Yasaitis is an expert at drawing different kinds of maps. At my request, she made me a map in which the size of every state was proportional to the number of people who landed in the “Medicaid gap.” (She couldn’t quite do that, since states such as California and New York would simply vanish. We drew each of these states as if they had shut out 2,000 state residents instead of zero. She also taught me how to make Cartograms. SO you may see more such items in this space.)

When we did all that, here’s what the US map would like if it were scaled by the number of affected people in each state (see below):



Yeah, it looks a bit different, doesn’t it? Nearly 90% of U.S. adults who fell in the Medicaid coverage gap live in the south.

These states have chosen to shut their poorest residents out of Medicaid. They have chosen to do so despite 100% federal subsidies (tapering down to the scandalously low level of…90%) for such expanded coverage. Two border states have rejected this hard-line approach. Arkansas reached a challenging compromise with the federal government. So did Kentucky. These states displayed the nation’s largest declines in their proportion of uninsured residents.

Meanwhile, the biggest southern states with large, poor, non-white populations have conspicuously demurred—despite ample evidence that the Obama administration is willing to make significant compromises with conservative governors and Republican legislatures across the nation to make this work.

Why have southern states have taken such a hard line that punishes so many people? I suspect the best explanation is complicated. Political party, the region’s historic legacy of racial inequality, the limited political influence of poor people-not least the word Obama in ObamaCare-all surely play a role. Whatever the explanation, millions of the nation’s poorest people are locked out of basic health coverage.

If Martin Luther King, Jr. were alive today, I am confident that he would be supporting causes such as North Carolina’s Moral Mondays movement, which is working to expand Medicaid. I wish they had more company.Governor Romney has recently announced that poverty reduction would be a major theme of his potential 2016 presidential run. He didn’t earn much credibility on this subject last time around. If Romney is looking for his own “Sista Souljah moment” to confront his party’s excessively conservative base, he might start by urging Republican colleagues across the south to address this disgraceful situation.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect,, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

2 thoughts on “This weird-looking Medicaid expansion map would sadden Dr. King on his holiday”

  1. Quite.
    I'm not sure about cartograms. They make their overall point, but the spatial distorsion is deliberately disorienting. You can convey the same information more accessibly by coloured dots, each representing say 10,000 people, so the number and visual density is proportional to the population affected. Here's one of the rural poor in the USA.

    dot density map

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