Yesterday's Wall Street Journal carried an article, "Trump Counties Would See Big Impact From Obamacare Repeal." In its analysis they found that the areas and types of voters that overwhelmingly voted for Donald Trump have the most to lose.
When he campaigned for president, Donald Trump made repealing and replacing the Affordable Care Act a signature issue. Polling suggests that such a move would have the biggest impacts on communities that gave Mr. Trump some of his highest levels of support, potentially complicating the politics of a repeal effort.
More than 20 million Americans now depend on the ACA, also known as Obamacare, for health insurance. Data from Gallup indicate that a lot of those people live in counties that favored Mr. Trump.
Voting against one's own self-interest is, of course, what Thomas Frank tried to understand is his important study, "What's the Matter With Kansas?", back in 2004. Some recent articles about the effects that Trump's victory have updated the question. These writers assume a very questionable future for Obamacare under a Republican administration and then examine how the people who voted for Trump are dealing with the likely demise or replacement of Obamacare. (Kentucky and West Virginia, which overwhelmingly supported Trump, are good examples.)
Sarah Kliff in Vox went to Kentucky to try to answer why Obamacare recipients voted for Trump:
There was a persistent belief that Trump would fix these problems and make Obamacare work better. I kept hearing informed voters, who had watched the election closely, say they did hear the promise of repeal but simply felt Trump couldn’t repeal a law that had done so much good for them. In fact, some of the people I talked to hope that one of the more divisive pieces of the law — Medicaid expansion — might become even more robust, offering more of the working poor a chance at the same coverage the very poor receive.
But as Kliff explains:
The political reality in Washington, however, looks much different: Republicans are dead set on repealing the Affordable Care Act. The plans they have proposed so far would leave millions of people without insurance and make it harder for sicker, older Americans to access coverage.
Reacting to Kliff's piece, Gary Legum in Salon points out the contradiction:
But well before Trump appeared on the scene, Kentucky voters had spent the entire Obama administration overwhelmingly voting to send the ACA’s sworn enemies to Congress to kill it, even as they themselves were benefiting from the law. It apparently never occurred to them that they might be seeding the ground for repeal. As long as they stuck it to the big-government coastal elites of the Democratic Party, not much else mattered.
Frank's book on Kansas pointed to cultural issues to as a partial explanation for this apparent contradiction. Similarly, Paul Krugman in a recent blog post for the New York Times points to cultural issues, putting particular emphasis on race:
A fact-constrained candidate wouldn’t have been able to promise such people what they want; Trump, of course, had no problem.
But is that really all there is? Working-class Trump voters do, in fact, receive a lot of government handouts — they’re almost totally dependent on Social Security for retirement, Medicare for health care when old, are quite dependent on food stamps, and many have recently received coverage from Obamacare. Quite a few receive disability payments too. They don’t want those benefits to go away. But they managed to convince themselves (with a lot of help from Fox News etc) that they aren’t really beneficiaries of government programs, or that they’re not getting the “good welfare”, which only goes to Those People.
And you can really see this in the regional patterns. California is an affluent state, a heavy net contributor to the federal budget; it went 2-1 Clinton. West Virginia is poor and a huge net recipient of federal aid; it went 2 1/2-1 Trump.
I don’t think any kind of economic analysis can explain this. It has to be about culture and, as always, race.
We will likely see more analysis as repeal/replacement gets closer to happening.
What would repeal of Obamacare mean for West Virginia? Last week, Renate Pore did an opinion piece for the Charleston Gazette-Mail. In the piece she cites a study by the Urban Institute to conclude:
184,000 West Virginia residents would lose coverage in 2019 under ACA repeal. We now have less than 100,000 uninsured residents. After repeal, the number of uninsured would jump up to 272,000. Without insurance, West Virginians will put off seeking care until their condition is serious or even life threatening, and more expensive to treat. Medical bill bankruptcies will destroy working West Virginia families.
According to the Gazette-Mail, Renate Pore is "chairwoman of the West Virginia Medicaid Coalition, a project of West Virginians for Affordable Health Care." I realize that Pore is a biased source on this subject but I could find very few sources that discussed the effects of Obamacare repeal on the state of West Virginia. (Local reporter Casey Junkins did write an article that was supposed to be about Obamacare's future. While the article called the Obamacare's future "uncertain," most of it was about the plan's current problems.) Even if we assume that Pore is stating a "worst-case scenario," repeal will certainly have consequences for the state.
