For many Trump vot­ers, Oba­macare’s demise will be a shock

The Denver Post - - PERSPECTIVE - By Greg Sar­gent

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

Twit­ter: @the­p­lum­linegs

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