Trump scammed many of his supporters

Ever since President Donald Trump was elected, launching the latest GOP drive to destroy Obamacare, some of us speculated that the GOP approach would hit many Trump voters hard. Trump strongly indicated to his working-class white supporters that he would not adopt a typical Republican’s ideological stance on health care that would leave many of them stranded. But now he has.

A new analysis by Nate Cohn of the Upshot confirms that Trump supporters may have the most to lose from the GOP plan to repeal and replace the Affordable Care Act. Here is a summary of its key finding, which is that those groups that stand to lose the most in subsidies to pay for health coverage on the individual market backed Trump:

• Those who stand to lose more than $7,500 in subsidies went for Trump by 58-39.

• Those who stand to lose between $5,000 and $7,500 went for Trump by 60-35.

• Those who stand to lose between $2,500 and $5,000 went for Trump by 49-45.

• Those who stand to lose between $1,000 and $2,500 went for Trump by 46-46.

To oversimplify, the analysis combined data from the Kaiser Family Foundation, which estimated how the GOP bill would impact people based on age, income and location of their insurance market, with data from the Cooperative Congressional Election Study, which surveyed tens of thousands of voters about their health care and their 2016 presidential vote. Merging them together, the analysis strives to reach a picture -- admittedly “imperfect” -- of how the respondents to the latter survey “would gain or lose under the Republican plan, based on age, income and county.”

The above conclusion is driven by the fact that the GOP plan, which replaces Obamacare’s subsidies with a tax credit scheme, ends up offering less financial assistance to older, lower-income Americans, particularly in rural areas where premiums are higher -- groups that tended to support Trump. On top of that, the plan would permit for higher premiums on older Americans (which is one reason AARP opposes it).

This new analysis reflects only part of the way Trump voters could be impacted by the GOP plan. It does not estimate its direct impact on those benefiting from the Affordable Care Act’s Medicaid expansion. But there is reason to believe a lot of them, too, would be adversely impacted. The GOP plan’s replacement for the expansion will likely lead to cuts over time and more large coverage losses. Meanwhile, Urban Institute data shows a large expansion in coverage among non-college-educated whites in Rust Belt states that flipped to Trump (Iowa, Ohio, Michigan, Wisconsin, Pennsylvania) and in some core Trump states (Indiana, West Virginia, Kentucky, Arkansas).

Note that virtually all of those states expanded Medicaid - so it’s reasonable to surmise that this played a big role in the huge drop in uninsured among those voters. Lending support to this conclusion, CNBC’s John Harwood points out that while nonelderly Medicaid enrollees tend to be nonwhite nationally, large majorities of them are white in some Rust Belt and red states that Trump won. It is likely they tilted for Trump and that many would lose out under the GOP plan.

Now, a couple of caveats. It is true that many Trump voters who benefit from ACA are still unhappy because of problems with its subsidy scheme. But the GOP plan would not solve this; it would be less generous. It is also true that Trump’s appeal to working-class whites centers not just on his vow of safety net help, but also of jobs -- a promise to bring manufacturing and coal jobs roaring back, and with it, the restoration of the old economic order.

But Trump did not only promise to restore that old economic order, via renegotiated trade deals and infrastructure spending (there is no assurance that under Trump either of these will actually do that, by the way). He also telegraphed that he envisions a robust government role in protecting the old, poor and sick and that this would guide the GOP replacement for Obamacare. This combination was arguably a driver of Trumpism’s appeal. But if he fails to carry out the former promise, even as he is now reneging on the latter one, the outcome for many Trump supporters could be doubly cruel. And it is almost certainly not what they thought they were voting for.