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Your State. Your Vote. Your Health. · Doctor AI: Rebuilding Trust in American Healthcare

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  Hello, this is Robin Blackstone.
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  It is Tuesday, October twenty-seventh, one week before election day in the United
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  States, and this is the second of four pieces on who decides your healthcare.
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  Yesterday, we drew a map.
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  Today, it's about your state and your vote.
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  Thank you for joining me
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  Texarkana is one town with a state line down the middle of it.
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  In Arkansas, about nine people in a hundred have no health insurance.
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  In Texas, nearly seventeen in a hundred.
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  Same town, same hospitals, same jobs, and a resident's odds of being
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  uninsured depend on which side of State Line Avenue she sleeps on.
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  The difference is a decision made in two state capitals.
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  That is why this piece of writing exists.
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  Yesterday, I gave you a map of who decides what in your healthcare.
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  Today, I give you your state.
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  One page for each of the fifty and the District of Columbia with the
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  numbers that describe your state and the names of the offices on
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  your ballot that will change them.
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  Find yours at robin.blackstone.com/yourstate.
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  Read it in five minutes.
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  Download it to your phone and vote.
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  This is what the fifty pages show when you lay them side by side.
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  The number that differs most.
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  Uninsured means a person who has no health coverage of any kind.
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  No employer plan, no Medicaid, no Medicare, nothing
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  bought on the marketplace.
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  The Census Bureau measures it two ways.
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  One survey asks whether you went the whole year without coverage.
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  That is the twenty-six point seven million person figure, seven point
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  nine percent of the American public that I used yesterday in our talks.
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  The other, the American Community Survey, asks whether coverage right
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  now and is large enough to give a figure for every single state.
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  The state figures below come from that.
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  For twenty twenty-four, the latest year published.
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  The twenty twenty-five state figures come out this Thursday, and I
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  will update every page that day.
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  The gap between states is wide.
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  In Massachusetts, fewer than three people in a hundred are uninsured.
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  In Texas, nearly seventeen in a hundred Hawaii, Vermont, and
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  the District of Columbia and New Hampshire are under five in a hundred.
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  Georgia, Oklahoma, and Nevada are over eleven.
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  Alaska sits right at eleven.
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  Most states are moving in the wrong way.
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  From twenty twenty-three to twenty twenty-four, the uninsured rate
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  rose in thirty-nine states, fell in eleven, and stayed the same in one.
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  That was before the twenty twenty-five reconciliation law,
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  which the Congressional Budget Office estimates will add about ten million
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  people to the uninsured by twenty thirty-four, and before the lapse
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  of the enhanced marketplace credits, another four point two million.
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  Depending on how the country votes, the United States moves toward one
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  person in eight without coverage, about twelve percent, or toward
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  fewer uninsured than we have today.
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  That's a large responsibility, and the outcome probably reaches
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  you or someone in your family, and that's not an abstraction.
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  This matters because through July this year, employers announced four hundred
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  and seventy-seven thousand job cuts, and the reason they named most often?
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  Artificial intelligence.
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  One hundred and thirteen thousand of them by Challenger,
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  Gray, and Christmas's count.
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  Seven in ten Americans expect AI to take jobs away, and the young expect it most.
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  In this country, when the job goes, the coverage goes with it.
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  The decision that explains most of it.
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  Since two thousand fourteen, the Affordable Care Act has offered
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  every state the same deal.
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  Cover adults earning up to a hundred and thirty-eight percent of the poverty line,
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  which under this year's guidelines is twenty-two thousand twenty-five dollars
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  for one person and forty-five thousand five hundred and forty dollars for a
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  family of four, and the federal government pays ninety percent of the cost.
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  Forty states and the District of Columbia took it.
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  Ten states did not.
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  They are Alabama, Florida, Georgia, Texas Kansas, Mississippi, South Carolina,
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  Tennessee, Wisconsin, and Wyoming.
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  The ten that said no are home to roughly eleven point six million of the country's
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  uninsured by my arithmetic from the census state rates and populations.
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  Texas alone, about five point two million.
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  The typical expansion state that took Medicare has an insured
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  rate of six point eight percent.
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  The typical non-expansion state, nine point seven percent.
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  Wisconsin is the exception that proves the rule.
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  It covers adults to the poverty line through a different arrangement and
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  sits at five point three percent Twenty-four states and the district
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  took the offer on the first day it was available, January one, twenty-fourteen.
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  The rest came one at a time over the next ten years, and in seven of them, the
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  legislature still has never agreed to it.
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  the voters did it themselves by ballot measure.
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  Maine in twenty-seventeen, Idaho, Nebraska, and Utah in twenty-eighteen,
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  Oklahoma and Missouri in twenty-twenty, and South Dakota in twenty-twenty-two.
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  Which brings me to South Dakota.
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  On November third, its voters will decide Constitutional Amendment One.
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  The Attorney General's official title for it is "Repeals Expanded Medicare
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  Coverage if Federal Funding for Expanded Coverage Drops Below Ninety Percent."
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  The sponsors say it only removes the state's obligation to pay if Washington
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  breaks the ninety percent promise.
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  The Attorney General's explanation says it ends the expanded coverage in that case.
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  Either way, it reaches back to the to an expansion that voters approved four
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  years ago, under which about thirty thousand people in the state are covered.
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  It is the only measure in the country this year that asks voters to loosen
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  their own grip on Medicaid, and it is worth watching from wherever you live
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  because the question it asks will be asked in other state houses next year.
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  So what is on your ballot?
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  Governors matter most, and the reason is simple.
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  In most states, the governor appoints the medical board, the
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  Medicaid director, and the insurance commissioner, and signs the budget
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  that pays state's share of Medicaid.
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  Thirty-six states elect a governor this year.
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  When you watch an incumbent decide or a candidate promise, ask whether
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  the decision is driven by the numbers or by a political philosophy.
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  Then ask how you would make that decision, knowing your family
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  might be the ones at risk.
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  The rest of what you will see by the official counts.
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  Number one, what is being decided on November third, twenty twenty-six, is
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  all four hundred and thirty-five seats in the US House of Representatives
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  and thirty-five Senate seats, thirty-three regular elections, plus
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  special elections in Florida and Ohio.
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  Number two, eighty-eight of the country's ninety-nine legislative
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  chambers in forty-six states.
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  In four states, Louisiana, Mississippi, New Jersey, and Virginia, they elect
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  no legislators, legislators this year.
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  Kansas, New Mexico, and South Carolina elect only their state
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  House of Representatives this year.
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  Number three, thirty attorneys general.
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  These are the officials who review hospital mergers and police
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  the medical debt collectors.
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  Number four, eleven states elect their insurance commissioner rather than
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  letting the governor appoint one.
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  They are California, Delaware, Georgia, Kansas, Louisiana, Mississippi,
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  Montana, North Carolina, North Dakota, Oklahoma, and Washington.
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  Four of those states are on the ballot this year: California,
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  Georgia, Kansas, and Oklahoma.
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  Five, in thirty-six states, through the governor you elect, the next
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  appointments to the medical board, the body now writing the rules on
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  whether you may use AI for your own health without a doctor's permission.
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  Your state's page lists which of these apply to you.
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  So where do you vote on health directly?
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  Most people assume election day comes with a stack of propositions.
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  It actually does not in most places.
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  This year, there are a hundred and sixty-four statewide measures in forty
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  states, a hundred and forty-five of them on the ballot for November 3rd,
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  but only a handful are about health.
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  In nine states, you will decide a health question yourself.
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  Everywhere else, the health decisions are made by the people we just
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  discussed, whose names will be on your ballot The nine places.
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  In these nine states, we've got propositions on the ballot.
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  Here's what they are.
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  In California, Proposition three makes permanent the top income tax rates that
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  fund schools, and in its title, healthcare
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  . Proposition thirty-eight borrows eight point four billion dollars
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  for immunology research, including cancer, heart disease, and Alzheimer's.
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  Proposition forty is a one-time tax of up to five percent on the net worth of
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  people with more than a billion dollars in assets, with ninety percent of the
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  money directed to your healthcare.
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  Proposition forty-four requires community health clinics to spend ninety
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  percent of their revenue on services.
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  Number two, Colorado.
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  Proposition one thirty-two makes possession of any
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  amount of fentanyl a felony.
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  Proposition one thirty-five bans certain surgeries on minors to
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  alter sex characteristics and bars Medicaid from paying for them.
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  Amendment eighty-seven raises income tax rates above five hundred thousand dollars
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  and directs the new money to schools, healthcare, and early childhood care.
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  In Idaho, Proposition one A right to reproductive freedom into state law.
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  HJR4 gives the legislature sole authority over legalizing marijuana and other
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  controlled substances, closing the door to citizen initiatives on the subject.
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  In Massachusetts, Question 8 ends the retail sale of recreational marijuana
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  ten years after voters approved it.
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  In Missouri, Amendment 3 repeals the Reproductive Rights Amendment voters
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  passed in twenty twenty-four, allows abortion only in cases of rape or incest
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  before twelve weeks, medical emergency, or fetal anomaly , and prohibits gender
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  transition procedures for minors.
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  In Nevada, Question 6 is the second and final vote on a constitutional
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  right to abortion before viability.
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  It passed sixty-four to thirty-six in twenty twenty-four.
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  In North Dakota, initiated constitutional measure number 2
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  requires public schools to serve free breakfast and lunch every school day.
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  In South Dakota, Amendment 1 described above.
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  In Virginia, Question 1 adds a right to reproductive freedom to the state's Bill
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  of Rights, recovering prenatal care, childbirth, birth control, abortion,
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  and miscarriage care and fertility care.
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  Your page quotes the official wording of your state's measures if there is one,
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  and states plainly if there is none.
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  The board you have never voted for.
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  Every state has a medical board.
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  It licenses doctors, takes licenses away, and decides what
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  tools may be used in practice.
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  Its members are, in the words of the board's own national federation, in
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  most cases, appointed by the governor.
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  You will never see their names on a ballot.
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  You will see the name of the person who chooses them.
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  Those boards are now drafting through your their federation model rules
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  on AI that work with limited or no direct physician supervision.
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  That drafting is happening in a closed committee with no member of the public.
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  The governor you elect next week will appoint the people whose
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  vote on those rules in your state How to use your state page.
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  Each page has the seven same seven parts, so you can compare your state with your
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  sisters, brothers, or family members.
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  Your numbers, population, uninsured rate, and count, and whether your state
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  expanded Medicaid at with the date.
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  Number two, where your state stands, how those numbers compare with the
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  other fifty, which way they moved, and how the Medicaid decision was made.
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  Number three, your ballot, which of the offices above are you electing this year?
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  Number four, health measures, your states in the official wording or
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  none, and the nine states deciding a health question directly.
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  Number five, where health decisions are not keeping up with future health.
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  Three places where decisions made for a system built around rescue
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  are being outrun by what is now possible, each with a question to
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  ask any candidate of any party.
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  The pages take no side.
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  There is no agreed definition of the minimal health every American
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  should have, and that argument is part of what this election is about.
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  Your medical board, who appoints it.
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  Your next step, your state's official election site with early voting
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  dates and your polling place, and the seven questions to ask any
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  candidate which come tomorrow.
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  Find your state at robinblackstone.com/yourstate.
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  Where I stand.
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  I am not a party, a member of any party.
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  No party's platform was written with me in mind, and I would rather judge
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  each candidate on what they will do about the things on these pages than to
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  adopt an agenda somebody else assembled.
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  This is not a paid announcement.
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  I'm not raising money.
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  Nobody is paying me to write this or do the work.
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  I am a surgeon who ran a national surgical society, worked inside one
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  of the largest health providers in the country, and finished a formal career
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  inside a large medical device company.
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  But my major qualification is that I've personally treated thousands
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  of people who needed my care.
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  I have conflicts of interest like everybody in this field.
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  I founded companies and the charity that carry this work,
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  and I write books about it.
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  None of them profit from how you vote.
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  On Wednesday, seven questions to ask anyone who wants your vote.
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  And on Thursday, five gifts the public already paid for and who can give them.
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  Your Vote Your Health already paid for.
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  First opinion from AI.
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  This is robinblackstone.com/yourstate is where to find your page.
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  And listed, uh, on all of these are the sources that I've used
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  to put the article together.
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  Find your state at robinblackstone.com/yourstate.
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  One page.
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  Save it to your phone.
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  Take it with you to vote.
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  Tomorrow, seven questions to ask anyone who wants your vote.
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  I'm Robin Blackstone.
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  Vote your health.
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  Thank you for listening