For the third consecutive election cycle, the health-care law figures to play a major role in this fall’s elections. The difference this year: The Affordable Care Act is a reality, with people enrolling in health insurance plans and paying premiums.
The costs of those plans differ from place to place. In states that rely on the federal insurance exchange, a move across a county line or from an urban to a rural area can mean a jump of more than $100 a month in premiums. Those jumps could sway how the ACA is viewed in November, especially in the suburbs — and that could matter in close House and Senate races where a few thousand votes could make a difference.
For months now, groups opposed to the health-care law have been spending millions on attack ads against it, particularly in states with key House and Senate races. And, more recently, insurance companies have begun advertising to get people enrolled.
But underneath that political fight, the cost differences remain. They are part of the private insurance system on which the law is built. Insurance costs have always varied from one locale to another, depending on the providers and available plans. The difference with the ACA is that people are now required to purchase one of those plans.
An examination of health-care premium data reveals some clear patterns nationally. Breaking down the costs by county, using a typology from the American Communities Project at American University, shows counties around major metro areas tend to do better as a group.
Counties that fall into the Big City, Urban Suburb, Middle Suburb or Exurb categories in this breakdown have an average monthly premium of about $199 for a Silver package for a 21-year-old. Rural counties, particularly counties with Native American and African American populations, generally face higher premiums, more than $230 on average.
But the impacts of the premiums are bigger than simple costs. There are three key points in understanding how premiums might affect different communities’ views of the ACA. First, are costs. Second, are how many in each community are uninsured. And third is household income, how much do families have to spend.