Updated Medicaid Expansion Map

This map shows which states have taken up the Affordable Care Act's (ACA) opportunity to expand each state's Medicaid program to citizens earning 101-135% of the Federal Poverty Limit (FPL).  The majority of states and DC are now participating with the Federal government picking up the entire tab for the expansion for the first year or so.  Then the states will after a few years have to pay for 10% of the expansion and the Federal government will continue to pay 90% of the tab.

Several key points:

• If you are like me and live in a state whose governor and legislature has chosen not to expand Medicaid insurance, then you and your fellow citizens are paying taxes into the Federal government to support the expansion, but your state is not getting any of the direct benefits.

• By some estimates 8 million uninsured Americans were eligible for their states' Medicaid programs but were unaware or at least not enrolled.  The media attention and efforts to sign people up for insurance, however, may be providing the indirect benefit of getting more people to sign up for Medicaid who are eligible.

• The ACA was designed for all the states to expand Medicaid to the poorest uninsured.  People earning <101% of the FPL were already eligible for Medicaid.  Those earning >135% up to 400% of the FPL get a subsidy to help them pay for private insurance purchased through the health insurance exchanges.  Everyone must by law have insurance.  So in states that did not expand Medicaid, these poorest of the uninsured must by law purchase insurance but do not get Medicaid ...and they get no subsidy.  They are trapped in the "Medicaid donut hole" as some are calling it.

This series of maps shows the classification of the state's 159 counties along a continuum from urban to rural.  This classification was developed by the US Department of Agriculture (by a fellow named Beale originally) and now is standardized by the US Office of Management and Budget (OMB).  It is based on urban population and commuting patterns for a county's workforce.  Thus, a rural county where a large percentage of the workforce commutes to a metro area would be classified as more urban than if its workers didn't access a more urban area regularly.

This map is a little rough.  I need to clean up some of the borders.  Here though is a map showing the Peach State's MSAs.  A Metropolitan Statistical Area is defined by urban population and workforce commuting.  

Georgia's AHECs

Most?  all?  states have AHECs (Area Health Education Centers).  This map shows Georgia's counties, health districts, and AHECs on one easy map.  

Georgia on My Mind

This next series of maps I'm starting to post today are ones I've made to help myself and colleagues who work in public health in Georgia.  This one shows Georgia's 159 counties.  Georgia has a boatload of counties; the second most of any state after Texas.  (Kentucky ranks 3rd by the way in the number of counties.)  Each county in Georgia has a health department which in turn is also part of 18 multi-county health districts.  

The Equality State of Wyoming, the first state to allow women to legally vote, on Friday became the 32nd state to legalize civil marriage for same sex couples.

Empty Homes in America's Cities

This map shows the percentages of vacant housing units in the 363 metros in the Lower 48 states.  It appears to highlight vacation homes.  Popular beach destinations such as Fort Myers (FL), Naples (FL), Panama Beach (FL), and Wilmington (NC) all show 25-50% of their housing units as vacation.  In one oceanside metro (Ocean City, NJ), 58% of housing units were recorded as vacant in April 2010.

And Marriages Are Back in Alaska

The US Supreme Court lifted the stay on marriages in Alaska today so it goes back to blue.

The Rapidly Changing Marriage Map

As expected, the various states in the 9th, 10th, and 4th appellate circuits are catching up this week to those courts' rulings striking down bans on same sex marriage:

• Civil marriage for same sex couples is now legal in North Carolina.  South Carolina continues to fight the ruling, but the law is fairly clear that South Carolina must also abide by the 4th circuit's ruling.  
• In the 10th circuit a Wyoming judge has said he will rule by Monday on whether to strike down Wyoming's ban.  I'm not quite sure what is going on in Kansas.
• In the 9th an Alaskan judge struck down that state's ban. Couples began marrying but the state was able to get a temporary stay.  So it has gone from blue back to pink.  And in Arizona a judge ruled today there to strike down that state's ban and marriages are starting there.  Plaintiffs in Montana are seeking the court to affirm the 9th's decision applies to Montana too.  

And while court watchers have been waiting eagerly for the ruling from the 6th, we are still waiting.

Longevity and Urban America?

This map is somewhat challenging to decipher.  It shows the percentage of the population who are 85 years of age or older for each of the lower 48 state's 363 metro areas.  The purple areas have in some cases nearly double the senior populations of the orange metros.  These purple areas have 2-4% of their population consisting of Americans who have lived 5-10 years longer than the average life expectancy of about 75.  Some areas popular with retirees like Florida's metro, Prescott (AZ), Santa Barbara (CA), and Asheville (NC) show up as purple.  So do wealthier areas in Massachusetts, Maine, and Connecticut where health care may be more accessible.  There is also a fair sprinkling of old Rust Belt and upper Plains metros where there has been a large out-migration of younger workers.  So, while intriguing to ponder whether residents of some cities live longer than their peers in other cities, this map has too many possible variables to show a clear pattern.

Urban Native America

For at least 15 millennia Native Americans made up all or the vast majorities of peoples living in the area that is now the United States.  Today all the metro areas in the eastern US and Hawaii have fewer than 5% of their populations who identify as Native American on the US Census.  In Oklahoma (the former Indian Territory), New Mexico, Arizona, Alaska, and South Dakota there are 9 metro areas where Native Americans make up 5% or more of the population.  In Flagstaff (AZ) and Farmington (NM) at least 1 in 4 residents are Native American.

Marriage Comes to Alaska

After a court ruling yesterday, civil marriage licenses are being issued to same-sex couples in Alaska today.  With Alaska there are now 30 states where same-sex couples can legally marry including now most of the West and 11 of the 13 original colonies.  Based on appellate decisions, 5 more states may have marriage soon.

Black Urban America

One of my former students once asked me which cities had the highest percentage of unmarried African-American professional men.  She was a young, unmarried African-American woman in graduate school and wanted to find a similar man.  I told her I didn't actually know.  Her guess was Atlanta or Chicago.

I still don't know the answer to my student's question, but this map shows the metro areas where African-Americans make up a larger percentage of the population.  In Alaska (not shown), Hawaii (not shown), much of the West, and in many of the urban areas of Appalachia, Black Americans make up fewer than 1 in 20 residents.  In fact, only in Las Vegas and Vallego-Fairfield (CA) do the percentages of African-Americans top 1 in 10 people.

From Louisiana to Maryland, however, Black residents constitute at least a quarter (1 in 4) of the population.  In only one metro (Albany, GA) Blacks are the majority.

Marriage Comes to North Carolina and Idaho!

It's 10pm Eastern.  I decided to post this map tonight as a kind of celebration.  This evening legal same sex civil marriage came to my home state of North Carolina.  I had long hoped but not necessarily believed this would happen in my lifetime.  I read tonight that marriage licenses were already being issued in Asheville.  Such great news!

I suspect that like women getting to vote and the racial and gender integration of schools in the 20th century, the effects of both same-sex and opposite-sex couples being able to legally marry (and divorce) will have effects both profound and almost unnoticeable.  The sky will not fall as some fear, but this huge and yet simple change will transform the lives of people like me...and you.  One can hide a lover; but not a spouse.  No more of this uncomfortableness of not knowing what to call a lesbian/gay friend's partner.  It will be a simple "spouse" or "wife" or "husband".  And that will take some getting used to for me...but already comes easier and with a smile to me.  I suspect soon it will be easier for most of us.  

Garth Brooks once said, he felt that one day his children would ask incredulously why gay people were ever banned from marrying in the first place.  I know that one day some wide-eyed college student will ask to interview me when I am older and ask about those terrible dark days of the past. How could that ever have been?

Sure.  A few people will still in time point to homosexuality as a sin, but I suspect many will interpret their Bibles differently in a generation the same way people do today over slavery, tattoos, pork, divorce, pre-marital sex, adultery, and the Biblical standard of women submitting to men.  I suppose if the good Christian people of Louisiana can see in their hearts to re-elect David Vitter for cheating on his wife Wendy with prostitutes he paid to have sex with him while he wore diapers, then maybe they won't mind if Ellen or Anderson Cooper get hitched for taxes and insurance and love and all that.  

It's a wonderful, warm night in Georgia as I scan the horizon for marriage coming down in time from those beautiful Appalachian Mountains to these pine forests.  And I pause in this moment of budding equality to also remember something my friend Kate once lamented:  that the radical gay agenda of free love and equality from the 1960s has over time matured into a very American and middle class dream.  Indeed, the radical gay agenda that gives some such heartburn has for many years been the dream to marry ...and have a stable job ...and serve our country in the military ...and go to church ...and to maybe even have kids...honestly, openly, and without fear of violence and hate.  And slowly it seems to me -but at lightening speed compared to the struggles our country has dealt with on gender, race, and religion- this American dream is blooming for us.  

And it truly is a dream for us all.  The struggles for women's rights continues to teach us that leadership and genius is not defined by genitals; that pink and pretty can fly or build or design an aircraft as well as blue and puppy dog tails.  The galaxy is bigger and better for having both Captain Janeways and Captain Kirks.

The same is true for the still on-going struggle for racial equality.  These struggles open our minds like an x-ray that we are all pretty much the same under these various hues of dermis.  We all love and cry and bleed and share a common humanity.  When we all have access to opportunity, our country is enriched for all by the incredible genius that hides among some of us regardless of our different skin colors and eye shapes and noses big or small; hooked, straight, or flat.

I once read an article by an opponent of gay rights who argued that while the women's and African American civil rights movements had brought something to all Americans, gay rights in his opinion were just a selfish affair without any lesson for us all.  I think he was wrong.  This movement has been about being a small, fearful group of Americans who are willing to be visible and out for the sake of dignity and family.  For all the labeling of homophobes under the banner of 'family values', gay rights has always been about enlarging our public and private circle of family; as if we were jointly making an America-sized Grinch's heart 2 sizes bigger.  I've heard so many times over the years people say they love their daughter or their nephew or liked that nice lesbian couple across the street, but they just didn't approve -mind you- of homosexuality.  But as always happens -isn't this so true?- love wins out.  From the OH Republican senator who endorses same sex marriage because he loves his son to the single mom who says she understands because her little family also doesn't fit the mold of the perfect family in all those ads, gay rights has won because individuals and advocacy groups have come out again and again -and again just for measure- to show that families come in many configurations but they all are powered by the same desire to cherish and protect the ones you love.  

And so, America's understanding of love and family has grown.  Lesbian and gay couples who have stood together -sometimes for decades- through violence, disease, derision (I hear those jokes too), and discrimination have held up a mirror to America's bridal industry and ultimately destructive focus on a single day's wedding ceremony to say "hey, marriage is the long years of standing up for each other and dealing with failures and successes...and all the responsibilities of marriage for decades before there will be any public benefits".  Without even a clear word to describe this other person in our lives, lesbian and gay Americans have been saying yes to the relationship long before there was even the dream of saying yes to the dress.  It's about hospital visitation and taxes and immigration and yes even divorce...and all the ups and downs of a real relationship beyond bouquets and layer cakes. And hopefully America has learned that marriage and family are about the long years of relationship and the love ...but it will be nice for gay folk to have some cake at last.

And that is a good thing.

Latest Civil Marriage Laws Map

The majority of Americans and the majority of American states now allow both opposite sex and same sex couples to legally wed.  Since this last Tuesday's decision by the US Supreme Court to not take up any of 7 appellate cases involving same sex marriage, a rush of new states now issue marriage licenses to same sex couples or are in the process of issuing:

• Colorado
• Indiana
• Nevada
• Oklahoma
• Utah
• Virginia
• West Virginia
• Wisconsin

Appellate decisions overturning bans on same sex marriage should also apply to the following states which are awaiting hearings to approve marriage as a legal formality or dealing with resistance to the court decisions by state officials:

• Alaska
• Arizona
• Idaho
• Kansas
• Montana
• North Carolina
• South Carolina
• Wyoming

The 6th Circuit should issue its opinion any day for the states of Kentucky, Michigan, Ohio, and Tennessee which could potentially legalize marriage in those states also...or create a case that would put them at odds to the 30 some pro-marriage decisions and send the case back to the US Supreme Court.

Race and Ethnicity in America's Metropolitan Areas

This map shows the cities with the largest percentages of a particular race or ethnicity.  Whites, Blacks, and Hispanics all form majorities in one or more metro areas.  Asians, Native Americans/Alaska Natives, Hawaiians/Pacific Islanders, and multi-racial Americans are not the majority in any metro in 2010.

Marriage Map Showing Appellate Circuits

I've updated yesterday's marriage map to show the US Court of Appeals Circuits.  There are 11 multi-state circuits plus the 12th, the District of Columbia circuit.  Thus, the 10th circuit court ruling for UT should also apply to WY, CO, and KS.  Colorado is now blue because the CO Attorney General says his state will comply with the appellate court ruling and begin issuing licenses.  

Similarly, the 4th circuit's ruling overturning VA's ban should also apply to NC, SC, and WV.  

Rulings by the 6th circuit based out of Cincinnati and the 9th based out of San Francisco are expected soon.  Cases before the circuit courts in the 5th and 11th are progressing.

Yesterday the five states directly affected by yesterday's Supreme Court decision to not take up the 7 same-sex marriage cases began moving towards offering marriage licenses.  Colorado's Attorney General also announced his state will begin issuing licenses.  On the other hand South Carolina's Attorney General announced he will continue to fight for the ban in his state.  

America's Hispanic Majority Metros

Seventeen of America's 366 metro areas have populations whose majority are Hispanic.  All 17 of these metros are found in the American Southwest from central California to Texas.  Historically these 17 urban areas have been part first of Spain's New World colonial empire and later Mexico.

America's most Hispanic metro area is Laredo, TX, where 97% of the population are Hispanic.

New Marriage Map Based on US Supreme Court Actions Today

Today the US Supreme Court declined to hear 7 same-sex marriage cases which have worked their way up through lower and appellate Federal courts.  Each of these 7 cases ruled bans on same-sex marriage were unconstitutional, but each case currently had a stay on allowing same-sex couples to get marriage licenses.

With the US Supreme Court declining to hear these 7 cases, the appellate decision stands, and the stays go away.  Thus, today same-sex marriage should be legal in VA, OK, UT, IN, and WI where appellate decisions have already been made regarding those states' bans.  Other states will also likely be affected since they are in the appellate court jurisdictions governed by these rulings (NC, SC, WV, KS, CO, and WY).  

Appellate courts that are expected to soon release their decisions soon that would affect:

6th Circuit:  KY, OH, TN, and MI

9th Circuit:  NV, ID, AZ, MT, and AK

With today's five new states, 51% of Americans live in states where same-sex couples will be able to legally wed.  If marriage equality spreads to the 6 other states (WY, KS, CO, NC, SC, and WV), 58% of Americans will live in a state where same-sex couples can marry.  

Note on the Sept. 10 map of ruling below:

There have now been two Federal court decisions in Louisiana:  one upheld the state's ban on same-sex marriage; the other ruled it unconstitutional.  Lower Federal rulings in the 5th (TX, LA and MS) and 11th (GA, AL, and FL) are still waiting to be reviewed by the appellate courts for those circuits.

America's Only Majority Black Metro

The majority of Black Americans live in urban areas, but African-Americans make up the majority of the population in only one metropolitan area:  Albany, GA.

Women Dominate American Metro Areas

Females make up the majority of Americans in part because women tend to outlive men.  This pattern holds true as well for most metro areas.  Indeed, females outnumber males in most metro areas.  There are, however, exceptions.  A number of metros in southern California and Utah have male majorities.  All the metro areas in Alaska and Hawaii are also majority male.  Some of the other male majority metros are college towns such as Blacksburg (VA), Columbia (MO), and Austin (TX).  Others such as Jacksonville (NC) and San Diego (CA) have large military bases.