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The #1 reason is that the Republicans sued to get out of expanding Medicaid* and the Supreme Court decided they could opt out if they wanted to. About half the states—all run by Republicans—did just that. Over the years some have realized it was a bad decision and changed their mind, but there are still 18 states that did not.As of early 2016, of the 20–30 million people who gained insurance due to ACA, 14.5 million people have gained insurance specifically through either Medicaid or SCHIP (children’s health insurance program) since ACA (Obamacare) was passed. 12 million of those are in the 32 states that opted to expand Medicaid**The source on the above Medicaid numbers was a report by the Department of Health & Human Services, compiled from the records submitted by each state at the end of 2015. You can see the report here (https://aspe.hhs.gov/system/files/pdf/187551/ACA2010-2016.pdf).Huffington Post did a nice break out that explained it well:States that undertook the expansion experienced significantly larger increases in the share of their residents with health coverage, compared to states that rejected the expansion and relied only on federally subsidized private health insurance from the exchange marketplaces to expand coverage. From 2013 to 2016, the uninsured rate fell 48 percent in expansion states and 28 percent in states that opted out of the Medicaid expansion.In non-expansion states, people below the poverty level get no help, because private insurance subsidies are available only to people who earn more than that.Obamacare’s Medicaid Expansion Slashed The Uninsured Rate — And The GOP Wants To Take It AwayEssentially, ACA would’ve covered millions more if 18 Republican states hadn’t excluded their citizens from its full benefits.Ironically, of those states that did expand Medicaid, some of the ones that have most benefited from ACA were red states, places like Arkansas, West Virginia, and Kentucky.If you look at the Worst 10 States in terms of how many of their citizens are uninsured, they’re all Republican run states that blocked their citizens from participating in the ACA Medicaid expansion:(also from Gallup-Healthways Well-Being Index, February 2017 via that Huffington Post link above. See link for further info)Texas and Florida are huge states and they’re on that list, which is basically a wall of shame. Forget the other 16 states, if those two alone had allowed the Medicaid expansion to proceed as planned, millions more would be covered.Blocking Medicaid’s expansion in 18 states is by far the #1 reason, accounting for millions of uninsured people. There are other reasons accounting for smaller numbers. The fine for lacking insurance might need to be higher and the subsidies to help people afford insurance might need to be higher as well. States that didn’t expand Medicaid created a big hole because their poorest citizens who would’ve qualified for help under the expansion do not qualify for subsidies for private health insurance because they were never intended to need it since they should’ve had Medicaid. If ACA were tweaked, they could be given access to subsidies to make up for the unforeseen GOP plot to deny them the benefits of the law.Also, the risk corridors which essentially re-insure insurance companies if they price their policies too low need to be better funded (Republicans blocked the funding). Improving the risk corridors would help keep premiums down since insurance companies could be more aggressive with their pricing without fear, which would encourage more robust enrollment.There are probably other little things and many could be addressed through tweaks to the ACA. Ultimately, we’ll never get to universal coverage without a system that makes more sense like the rest of the advanced countries of the world, not this patchwork system we have where people get health coverage from their employers, Medicare, Medicaid, SCHIP, TriCare, the VA, the private exchanges, and probably others I’m not thinking of. Whether our system should look more like Canada’s or the UK’s or Sweden’s or Germany’s or any of the other couple dozen countries with superior coverage at far lower costs is another question, but this patchwork approach is a losing battle because costs will never be brought under control that way and that’s ultimately the elephant in the room on every discussion. None of this is free or cheap but we keep choosing to continue the most expensive approach there is.``*which would’ve been 100% covered by the federal government for 3 years and 90% after that**2 million people in the non-expanding states were still able to get coverage because they were already eligible but didn’t realize it until ACA’s publicity (and possibly the mandate) led them to take advantage of the benefits they were already eligible for.

Mississippi is the worst state in the nation on most measures of health. A compiled analysis available here ranks it as the unhealthiest state in the nation. West Virginia doesn’t fare much better, ranked #42 for overall health.“48 states have allowed vaccination exemption based on personal belief or religious grounds. Therefore, it should be possible to see if these two states have achieved something that the other 48 states did not. Such information can also be used to justify similar laws in the other states.” However, the evidence surprisingly justifies allowing philosophical and religious exemptions to improve health outcomes on the following measures explained in detail below.VACCINE PREVENTABLE DISEASES [1][1][1][1]Let’s look at the incidence of “vaccine-preventable diseases” in those states (WV and MS) compared to two states that have* philosophical and religious exemptions (California and Oregon).Chicken Pox (Varicella)Forced Vaccinations:West Virginia: 116 cases (63 per 10 million)Mississippi: 5 cases (17 per 10 million)Exemptions:California: 30 cases (7.7 per 10 million)Oregon: 0 cases (0 per 10 million)Hepatitis BForced Vaccinations:West Virginia: 195 cases (1054 per 10 million)Mississippi: 55 cases (18 per 10 million)Exemptions:California: 138 cases (35 per 10 million)Oregon: 32 cases (81 per 10 million)MeaslesForced Vaccinations:West Virginia: 0 indigenous cases (0 per 10 million)Mississippi: 0 indigenous cases (0 per 10 million)Exemptions:California: 7 indigenous cases (1.8 per 10 million)Oregon: 3 indigenous cases (0.7 per 10 million)Rubella and PolioForced Vaccinations:West Virginia: 0 cases (0 per 10 million)Mississippi: 0 cases (0 per 10 million)Exemptions:California: 0 cases (0 per 10 million)Oregon: 0 cases (0 per 10 million)So, whether exemptions are allowed in the state does not necessarily correlate to fewer incidents of disease. Measles is the only case above where we see a difference between the incidence in WV and MS versus in CA and OR in cases, but when adjusted for population there is no statistical significance, in fact Mississippi’s rate is higher than California’s.VACCINATION RATES [2][2][2][2]MMR & DTaP CoverageForced Vaccinations:West Virginia: 97.6%Mississippi: 99.2%Exemptions:California: 92.6%Oregon: 94.1%Note that these coverage rates are for every recommended dosage. So a certain percentage have received a few doses, just not the entire series.INFANT MORTALITY [3][3][3][3]What about infant mortality? Forced vaccinations correlate with a worse infant mortality rate in WV and MS.Forced Vaccinations:West Virginia: 7.33 deaths per 1,000 births (rank # 10 in infant mortality)Mississippi: 9.62 deaths per 1,000 births (rank # 1 in infant mortality, the worst in the nation)Exemptions:California: 4.74 deaths per 1,000 births (rank #44 in infant mortality).Oregon: 4.96 deaths per 1,000 births cases (rank #39 in infant mortality)LIFE EXPECTANCY [4][4][4][4] [5][5][5][5]Forced Vaccinations:West Virginia: 75.4 (rank #49 2nd worst in the nation 1,178 deaths per 100,000 people)Mississippi: 75 (rank #50 worst in the nation 1,026.4 deaths per 100,000 peopleExemptions:California: Age 80.8 (rank #4, 647.9 deaths per 100,000 people)Oregon: Age 79.5 (rank #19 863.6 deaths per 100,000 people)West Virginia and Mississippi are the worst two states for life expectancy.When only medical exemptions are granted, doctors are subjected to strict scrutiny when they issue an exemption. Many doctors are thus hesitant to grant an exemption for fear of retaliation. This is an issue already with the new forced vaccination law in California [6][6][6][6]. The political climate surrounding vaccination necessitates the need for philosophical exemptions. Parents in consultation with doctors need to make the medical decisions for their children. There should not be a blanket law that applies to everyone, regardless of their medical history. Philosophical exemptions are needed for legitimate medical issues. According to the CDC, if your child suffered a seizure as a result of a vaccination or Guillan-Barre Syndrome, your child is still required to receive additional doses of the same vaccine that caused the reaction. Parents and doctors should get to decide that, not the state legislature, which is currently the case in WV, MS, and now CA (under SB 277).*Note that in 2016, California removed non-medical exemptions and adopted an even more stringent policy than WV and MS. This data was taken from 2013 (the most recent CDC reporting year) when philosophical exemptions were still allowed by law. This change was justified because of the public health improvements it would make (increasing vaccination coverage by 2.54%). But, as the evidence from MS and WV show, there really isn’t a positive correlation. If anything, the cases show the need for philosophical and religious exemptions.Footnotes[1] Summary of Notifiable Infectious Diseases and Conditions - United States, 2013[1] Summary of Notifiable Infectious Diseases and Conditions - United States, 2013[1] Summary of Notifiable Infectious Diseases and Conditions - United States, 2013[1] Summary of Notifiable Infectious Diseases and Conditions - United States, 2013[2] Vaccination Coverage Among Children in Kindergarten - United States, 2014-15 School Year[2] Vaccination Coverage Among Children in Kindergarten - United States, 2014-15 School Year[2] Vaccination Coverage Among Children in Kindergarten - United States, 2014-15 School Year[2] Vaccination Coverage Among Children in Kindergarten - United States, 2014-15 School Year[3] http://www.cdc.gov/nchs/pressroom/states/infant_mortality_rates_state_2010.pdf[3] http://www.cdc.gov/nchs/pressroom/states/infant_mortality_rates_state_2010.pdf[3] http://www.cdc.gov/nchs/pressroom/states/infant_mortality_rates_state_2010.pdf[3] http://www.cdc.gov/nchs/pressroom/states/infant_mortality_rates_state_2010.pdf[4] http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf[4] http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf[4] http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf[4] http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf[5] List of U.S. states by life expectancy[5] List of U.S. states by life expectancy[5] List of U.S. states by life expectancy[5] List of U.S. states by life expectancy[6] SB 277 lawyers drop bombs on the California health department[6] SB 277 lawyers drop bombs on the California health department[6] SB 277 lawyers drop bombs on the California health department[6] SB 277 lawyers drop bombs on the California health department

There are a lot of answers to this question based upon opinion only.Here are some documented facts:#1- Children in father-absent homes are almost four times more likely to be poor. In 2011, 12 percent of children in married-couple families were living in poverty, compared to 44 percent of children in mother-only families.Source: U.S. Census Bureau, Children’s Living Arrangements and Characteristics: March 2011, Table C8. Washington D.C.: 2011.So throw out all those TV examples of a single mother happily raising a kid. Sure there are examples but they are exceptions- it is not reality. Get it? TV or 'someone you know down the block who is doing fine' is not the reality.#2- Children living in female headed families with no spouse present had a poverty rate of 47.6 percent, over 4 times the rate in married-couple families.Source: U.S. Department of Health and Human Services; ASEP Issue Brief: Information on Poverty and Income Statistics. September 12, 2012#3- And children born to poverty is trending upward:Source: U.S. Department of Health and Human Services; ASEP Issue Brief: Information on Poverty and Income Statistics. September 12, 2012http://aspe.hhs.gov/hsp/12/PovertyAndIncomeEst/ib.shtml#4- “Fatherless children are at a dramatically greater risk of drug and alcohol abuse.”Source: U.S. Department of Health and Human Services. National Center for Health Statistics. Survey on Child Health. Washington, DC, 1993."Children of single-parent homes are more than twice as likely to commit suicide."Sources: The Lancet, Jan. 25, 2003 • Gunilla Ringbäck Weitoft, MD, Centre for Epidemiology, the National Board of Health and Welfare, Stockholm, Sweden • Irwin Sandler, PhD, professor of psychology and director of the Prevention Research Center, Arizona State University, Tempe • Douglas G. Jacobs, MD, associate clinical professor of psychiatry, Harvard Medical School; and founder and director, The National Depression Screening Program • Madelyn Gould, PhD, MPH, professor of child psychiatry and public health, College of Physicians and Surgeons, Columbia University; and research scientist, New York State Psychiatric Institute.Single-Parent Homes Increase Risk of Child Suicide#5- Educational Achievement– Children living with their married biological father tested at a significantly higher level than those living with a nonbiological father.- Children in grades 7-12 who have lived with at least one biological parent, youth that experienced divorce, separation, or nonunion birth reported lower grade point averages than those who have always lived with both biological parents.Source: Tillman, K. H. (2007). Family structure pathways and academic disadvantage among adolescents in stepfamilies. Journal of Marriage and Family.– Father involvement in schools is associated with the higher likelihood of a student getting mostly A’s. This was true for fathers in biological parent families, for stepfathers, and for fathers heading single-parent families.Source: Nord, Christine Winquist, and Jerry West. Fathers’ and Mothers’ Involvement in Their Children’s Schools by Family Type and Resident Status. (NCES 2001-032). Washington, D.C.: U.S. Department of Education, National Center for Education Statistics, 2001.– 71% of high school dropouts are fatherless; fatherless children have more trouble academically, scoring poorly on tests of reading, mathematics, and thinking skills; children from father-absent homes are more likely to be truant from school, more likely to be excluded from school, more likely to leave school at age 16, and less likely to attain academic and professional qualifications in adulthood.Source: Edward Kruk, Ph.D., “The Vital Importance of Paternal Presence in Children’s Lives.” May 23, 2012.http://www.psychologytoday.com/blog/co-parenting-after-divorce/201205/father-absence-father-deficit-father-hunger#6- CrimeCompared to peers in intact families, adolescents in single-parent families and stepfamilies were more likely to engage in delinquency. This relationship appeared to be operating through differences in family processes—parental involvement, supervision, monitoring, and parentchild closeness—between intact and non-intact families.Source: Stephen Demuth and Susan L. Brown, “Family Structure, Family Processes, and Adolescent Delinquency: The Significance of Parental Absence Versus Parental Gender,” Journal of Research in Crime and Delinquency 41, No. 1 (February 2004): 58-81.Marriage and Family as Deterrents from Delinquency, Violence and CrimeA study using data from the National Longitudinal Study of Adolescent Health explored the relationship between family structure and risk of violent acts in neighborhoods. The results revealed that if the number of fathers is low in a neighborhood, then there is an increase in acts of teen violence. The statistical data showed that a 1% increase in the proportion of single-parent families in a neighborhood is associated with a 3% increase in an adolescent’s level of violence. In other words, adolescents who live in neighborhoods with lower proportions of single-parent families and who report higher levels of family integration commit less violence.Source: Knoester, C., & Hayne, D.A. (2005). “Community context, social integration into family, and youth violence.” Journal of Marriage and Family 67, 767-780.Children age 10 to 17 living with two biological or adoptive parents were significantly less likely to experience sexual assault, child maltreatment, other types of major violence, and non-victimization type of adversity, and were less likely to witness violence in their families compared to peers living in single-parent families and stepfamilies.Source: Heather A. Turner, “The Effect of Lifetime Victimization on the Mental Health of Children and Adolescents,” Social Science & Medicine, Vol. 62, No. 1, (January 2006), pp. 13-27.#7- Sexual Activity and Teen PregnancyBeing raised by a single mother raises the risk of teen pregnancy, marrying with less than a high school degree, and forming a marriage where both partners have less than a high school degree.Source: Teachman, Jay D. “The Childhood Living Arrangements of Children and the Characteristics of Their Marriages.” Journal of Family Issues 25 (January 2004): 86-111.#8- There is causality. The role of poverty is indicated, in the cite below, as a cause but secondary to fatherlessness."The low supervision of adolescents frequently found in father-absent homes...was more often the cause of delinquency than poverty. Boys from father-absent homes are more likely to commit a school crime. The likelihood that a young male will engage in criminal activities doubles if he is raised without a father and triples if he lives in a neighborhood with a high concentration of single-parent families.Seventy percent of the juveniles in state reform institutions grew up in a single- or no- parent situations. Seventy-two percent of adolescent murderers grew up without fathers. In summary, fatherless children are at a dramatically greater risk for drug and alcohol abuse, mental illness, suicide, poor educational performance, teen pregnancy, and criminality.Source-Forensic Mental Health Assessment- A Casebookpg. 158Written by:Kirk Heilbrun, Professor and Chair of the Department of Clinical and Health Psychology, Drexel University College of Medicine, ‎Psychology Section of the Department of Psychiatry Yale UniversityGeoffrey Marczyk Predoctoral Fellow and ‎David DeMatteo Predoctoral Clinical Psychology Intern, Medical College of VirginiaNOTE- While I agree that fatherlessness has a more direct cause to teen drug abuse, poor educational performance, criminality, etc., I do not shrug off poverty as less important. In my opinion, it is a cause, not of adolescent anti-social behavior, but of fatherlessness. It is at this level where, I feel, the problem should partly be addressed, and wherein lies a part to the ultimate answer to the original question. The scheme goes like this: poverty + lack of individual responsibility leads to fatherlessness which leads to teen problems.Now, let's get to the most emotionally-charged part. And let's be honest. Is this a black problem? A white problem? Or what? This is the part where people feel most uncomfortable.But it's an important question because the more you know the victims, the better solutions you can have.And the data suggests that the lack of live-in fathers is most striking in the black community. But it is not only a black problem.Here is the data from the federal Centers for Disease Control and Prevention, which publishes a report every year that includes a wealth of data about births in America. The most recent report, published in August 2012, is based on data from 2010.The report broke down statistics by ethnic groups. Here’s a summary:Racial or ethnic groupPercent of births considered "non-marital"Asian Americans and Pacific Islanders17 percentNon-Hispanic whites29 percentHispanics53 percentAmerican Indian and Native Alaskans66 percentNon-Hispanic blacks73 percentAnother chart below summarizes 2011 Census Bureau data compiled by Kids Count, a project of the Annie E. Casey Foundation. The group defined "children in single-parent families" as kids under 18 who live with their own single parent; it includes children living with a parent and a cohabiting adult, but it does not include children living with married step-parents.Racial or ethnic groupChildren in single-parent familiesAsian Americans and Pacific Islanders17 percentNon-Hispanic whites25 percentHispanics42 percentAmerican Indian and Native Alaskans53 percentNon-Hispanic blacks67 percentIt is not a 'black problem' only. In fact, even in places where the percentage of the black population declined, single parenthood increased over the past decade, according to The Washington Times’ analysis of census data. In South Carolina, where the black share of the population fell by 2 percent, single parenthood rose by 5 percent. In Kentucky and Louisiana, where the black population was constant, single parenthood increased 6 percentage points.http://www.washingtontimes.com/news/2012/dec/25/fathers-disappear-from-households-across-america/#ixzz3ahYGXuXQSo what to do?Some of the solutions might be the same across the racial board and some might have to be specific. Take alcoholism and smoking cigarettes as an example. There are significantly more billboards pushing drinking and smoking in black neighborhoods than there are in white (not to mention liquor stores per capita). So any attempt to decrease drinking and alcoholism in black neighborhoods has to take this into consideration. It therefore requires a different set of answers than 'white neighborhoods'.Take economics, for example. The National Bureau of Economic Research found that "Job applicants with white names needed to send about 10 resumes to get one callback; those with African-American names needed to send around 15 resumes to get one callback."Employers' Replies to Racial NamesSo if a job gives oneself pride and higher self-esteem, in addition to better financial stability, we have to quickly realize that black men have a much higher hurdle to overcome than a white man as far as maybe the single most important factor effecting fatherhood- a job.So there is no doubt in my mind that there are higher barriers effecting many black men from becoming more responsible fathers. These barriers need to be addressed more than they have been, so that non-whites feel they have an equal shot at the pie.But I am not taking the unemployed, uneducated individual off the hook. Individuals have to have accountability.In his book “Enough,” journalist Juan Williams points out that, “The answer to the question of how to create opportunities for the poor is to get them to take school seriously, to set up high academic expectations for their children and to insist on high expectations from teachers in good schools. It is also a personal matter of self-control that begins with understanding the power of the family and putting love, romance, and children (as well as knowing how to be good parents) in their proper order.”Linda Chavez, the former head of the U.S. Civil Rights Commission, echoes this sentiment. She says that the “chief cause of poverty today among blacks is no longer racism: it is the breakdown of the traditional family.”Page on commdiginews.comA real-life example of this: About 15 years ago the District of Columbia public schools district was very concerned about its students' poor academic performance and absenteeism. Minorities make up the vast majority of its students.As a way to combat this problem the District decided to hold a district-wide meeting with parents of the students, in order to discuss ways to solve this problem. They sent out mailers and made phone calls telling the parents the time and place of the meeting. Of the ~45,000 students which make up the District less than 10 parents showed up!When I first heard this I thought 'of course- these people can't take off work, or maybe don't have a car and can't afford the time and expense to go by bus, etc.Except the District decided to try again. This time they offered free food as an enticement. Attendance jumped to over 1,000 parents.Here are some interesting quotes:Juan Williams-(Anyone who just wants to blame poverty can) .... say this with a straight face, even though they say this knowing that in 1964, in a far more hostile and racist America, 82 per cent of black households had both parents in place and close to half of those households owned a business.”President Obama-“If we are honest with ourselves, we’ll admit that too many fathers are…missing…from too many lives and too many homes. ....We know that more than half of all black children live in single parent households, a number that has doubled since we were children.”Here is a fascinating statistic-Economist Walter Williams notes that:“black Americans as a group have made some of the largest gains over some of the highest hurdles in the shortest time of any group in history.If black Americans were a nation, they would be the sixteenth richest on earth.Some of the richest, and most famous, people in the world are black Americans. Colin Powell led the mightiest army in human history. In 1865 neither a slave nor a slave owner would have believed this kind of progress was possible in a little over a century, if ever. As such it speaks to the intestinal fortitude of a people and, just as important, to the greatness of the nation where such gains were possible — gains that would have been impossible anywhere except the United States.”Yet, Williams points out:“For many blacks, these gains are elusive, perhaps for 30 percent of our community.It does the poor no favors to blame their problems on racism, which has been diminishing as the pathologies got worse. In 1940, the black illegitimacy rate was around 14 percent. Now, it’s 75 percent. In 1870, right after slavery, 70 to 80 percent of black families were intact. Now only 30 percent of black kids live in two-parent families.Some 51 percent of homicide victims are black, as are 95 percent of their killers. You can’t blame this on white people. The rotten schools black kids attend are mostly in cities where black adults are in control and spending a lot of taxpayers’ money on those schools.”Page on commdiginews.comIt doesn't help a struggling woman caring for her child alone, whether she is Black, White, Hispanic or Asian, if people are afraid to talk about the problems she has out of fear of being thought of as a racist. Or if they want to drop all the responsibility for it at the foot of 'the system', and ignore the fact that things are significantly better today than they were 50-75 years ago, but that the fatherless trend is still shooting upwards.The solution is in both the system and individual. Anyone who is serious about changing these trends need first to recognize them and point their finger right in the face of those who need to do better. Whatever color they are.