For many Trump voters, Obamacare’s demise will be a shock
Donald Trump has chosen GOP Rep. Tom Price of Georgia, a longtime critic of the Affordable Care Act, as his secretary for Health and Human Services. This likely means that, at best, the health law will be repealed and replaced by something that covers far fewer people, or that, at worst, it will get repealed outright, leaving even more people without coverage.
So what does this mean for poor and working-class white Trump voters who are currently benefiting from the law, some no doubt enjoying health coverage for the first time in their lives?
Unlike many Republicans, Price has at least given a lot of thought to how to replace the ACA. But Price’s own replacement proposal would roll back the Medicaid expansion, a substantial portion of financial assistance for others getting coverage, and a fair amount of regulation of the individual market. And so, the likely end result is that a lot of the 20 million people who would lose coverage due to repeal will remain without coverage, and protections for those with bad medical conditions will be eroded.
The core philosophical difference here is that conservatives want far less in government spending and regulations designed to cover poor and sick people, protect consumers and enforce a minimum standard for coverage. As a result, they are willing to tolerate far lower standards in those areas, though some also want conservative reforms to strive to make very cheap bare-bones catastrophic coverage widely available.
Liberals think we should spend and regulate to the
degree necessary to move toward universal care and see expanded and improved coverage as part of a broader effort to progress towards a higher societally guaranteed minimum standard of living. Conservatives won the election, and apparently, we are now going to do it their way. Elections have consequences.
Indeed, all this should immediately cast doubt on the notion that Trump will clash with congressional Republicans over the future of the safety net. During the primaries, Trump famously said he would not allow people to “die on the street,” which, along with his vows not to touch entitlements, led many to see him as an unorthodox Republican when it comes to the proper scope of government protections for the poor and unhealthy. But now Trump appears prepared to go along with the most conservative congressional Republicans on these matters.
I have obtained new numbers from the Gallup-Healthways Well-Being Index that suggest that a lot of poor and workingclass whites — who voted for Trump in disproportionate numbers — have benefited from Obamacare, meaning they likely stand to lose out from its repeal. GallupHealthways numbers from earlier this fall showed that overall, the national uninsured rate has plummeted to a new low of 10 percent, a drop of over six percentage points since the law went into effect.
But that drop, it turns out, is even more pronounced among poor whites. GallupHealthways tells me that among whites without a college degree who have household incomes of under $36,000, the uninsured rate has dropped from 25 percent in 2013 to 15 percent now — a drop of 10 percentage points. It’s often noted that the law has disproportionately expanded coverage among African-Americans and Latinos. That is correct, but it has also disproportionately expanded coverage among poor white people.
Now, it’s hard to know how many people we’re talking about here. But other evidence supports the idea that a lot of red state voters have gained coverage from the law. In some parts of rural Kentucky, the Medicaid expansion has greatly expanded coverage. And CBS News recently reported that even some Republican officials in the GOP-led states that expanded Medicaid are not prepared to see that evaporate. Gallup-Healthways numbers also show that the drop in the uninsured rate has outpaced the national average in some red states that have expanded Medicaid.
Did people benefiting from Obamacare who voted for Trump really expect repeal to happen? I think we need more reporting on this question. Yes, Trump did repeatedly say he would repeal Obamacare. But he also said he would replace it with “something terrific.” And he explicitly went out of his way to create the impression that he does not agree ideologically with Republicans who are hostile to government efforts to supply health care to those who can’t afford it.
Now, it’s always possible that many voters backed Trump in the full knowledge that their Obamacare might be repealed, for other reasons — because, for instance, he’ll supposedly bring manufacturing and coal jobs roaring back. Before long, those voters will learn whether their bet was a well-placed one. It’s also possible that Trump will surprise us all and insist on some kind of replacement that somehow preserves much of Obamacare’s coverage expansion.
But it now looks more likely that we’ll see a substantial rollback of the progress toward universal health coverage we’ve seen in the past few years. News organizations love to venture into Trump’s America to hear voters explain that Trump spoke far more directly to their economic struggles than Democrats did. Maybe now we’ll get more coverage of those inhabitants of Trump’s America who are set to lose their health care, too.
Greg Sargent writes The Washington Post’s Plum Line blog. Follow him on