Sun Sentinel Palm Beach Edition
Trump backers may lose in health bill
Analysis finds older, rural, poorer voters would be hurt most
WASHINGTON — Americans who swept President Donald Trump to victory — lower-income, older voters in conservative, rural parts of the country — stand to lose the most in federal health care aid under a Republican plan to repeal and replace the Affordable Care Act, according to a Washington Bureau analysis of county voting and tax credit data.
Among the hardest hit under the House bill are 60-year-olds with annual incomes of $30,000. In nearly 1,500 counties nationwide, such a person stands to lose more than $6,000 a year in federal insurance subsidies. Ninety percent of those counties backed Trump, the analysis shows. And 68 of the 70 counties where these consumers would suffer the largest losses supported Trump in November.
Most affected by the GOP plan would be parts of Alaska, Arizona, Nebraska, Oklahoma and Tennessee, where Obamacare subsidies have been critical to making insurance affordable. All five states went for Trump. Also hit hard would be parts of key swing states that backed Trump, including Michigan, North Carolina and Pennsylvania.
Meanwhile, higher-income, younger Americans — many of whom live in urban areas won by Democrat Hillary Clinton — stand to get more assistance in the GOP bill.
Faring best would be the nation’s wealthiest residents, who would see a substantial tax cut with the elimination under the House GOP bill of two levies on high-income taxpayers. These taxes — on individuals making more than $200,000 and couples making more than $250,000 — were included in Obamacare to help offset the cost of assisting lowerincome Americans.
The disproportionate impact of the GOP plan threatens to undercut one of Trump’s core promises that he would take care of all Americans even if the health care law is repealed.
“Republicans may seem very happy to slap their constituents in the face while picking their pockets,” said Mark Mellman, a Democratic political consultant who has worked in red states. “But I think they will rue the day they did this.”
Only a small share of the electorate receives Obamacare subsidies, but the loss of aid could deprive tens of millions of a lifeline.
The Washington Bureau analysis is based on county election results compiled by The Associated Press and a report by the nonprofit Kaiser Family Foundation of the projected value of insurance subsidies in 2020 under current law and under House Republicans’ proposed alternative.
The House GOP plan is already facing fierce criticism from many patient advocates, including AARP, whose membership includes not only seniors on Medicare but many Americans ages 50 to 65.
“Older Americans need affordable health care services and prescriptions,” said Nancy Lea Mond, executive vice president of AARP. “We are very concerned that this plan goes in the opposite direction, increasing insurance premiums for older Americans and not doing anything to lower drug costs.”
The potential impact of the House bill is making many GOP lawmakers uncomfortable, including senators from Alaska, Arkansas, Ohio and West Virginia, which have large numbers of low-income white voters who have benefited from Obamacare.
For years, Trump and other Republicans attacked the health care law for saddling some consumers with unaffordable health care.
But many of the areas where Trump won big have been helped most by Obamacare’s system of subsidies, which were designed to assist Americans who earn too much to qualify for government Medicaid but can’t afford to buy health insurance on their own.
The assistance helps consumers making up to four times the federal poverty level — or about $48,000 a year. About 8 million Americans who buy coverage on insurance marketplaces such as HealthCare.gov receive subsidies.
Larger subsidies are available for people making less money and for people living in regions of the country where health insurance is most expensive.
In Alaska, which has the nation’s highest insurance costs, a 60-year-old resident with a $30,000 income qualified this year for $21,048 in federal aid to get health insurance, according to HealthCare.gov.
That kind of assistance makes a difference. For example, a health plan from insurer Premera Blue Cross Blue Shield that would normally cost a 60-year-old shopper in Anchorage $1,867 a month costs just $113 after Obamacare subsidies.
Older, lower-income consumers can get similar savings in many rural parts of the country, largely because health insurance tends to be much more expensive in these regions as there is less competition among medical providers and insurers.
“It is kind of the reverse of what people might think,” said Cynthia Cox, an analyst with Kaiser who worked on the tax credit data.
Obamacare subsidies in urban areas have tended to be lower.
The House plan offers a flat subsidy to people based on how old they are. Americans who are younger than 30 would get $2,000. That subsidy would then increase up to $4,000 for people who are 60 or older.
This new system would result in huge losses for lower-income, older residents of many rural regions, Kaiser’s analysis shows.
Trump and other Republicans insist that voters will reap the benefits of the GOP alternative. The president last week pledged an Obamacare replacement that would “lower costs, expand choices, increase competition and ensure health care access for all Americans.”