Which raises a question: Did voters such as these know they were voting for this? After all, Trump promised countless times throughout the campaign to repeal the Affordable Care Act, didn’t he? If they are complaining about this now, don’t they have only themselves to blame?
No. I’m going to argue that, while Trump did repeatedly vow repeal, these voters were absolutely right to conclude that he would not leave them without the sort of federal protections they enjoy under Obamacare. That’s because Trump did, in fact, clearly signal to them that this would not happen.
The CNN segment features people who live in Eastern Kentucky coal country and backed Trump because he promised to bring back coal jobs. Now, however, they worry that a provision in the ACA that makes it easier for longtime coal miners with black lung disease to get disability benefits could get eliminated along with the law. That provision shifted the burden of proving that the disability was directly caused by work in the mines away from the victim. Those benefits include financial and medical benefits. Some benefits now also extend to the widows of miners who had black lung disease — or pneumoconiosis, a lung illness associated with inhalation of coal dust — after their husbands die. Other reporting has also confirmed widespread coal country worries about losing these protections.
One man who worked in the mines for 35 years told CNN’s Miguel Marquez:
“When they eliminate the Obamacare, they may just eliminate all of the black lung program. It may all be gone. Don’t matter how many years you got.”
The widow of a deceased miner, who is now trying to get the benefits, said she doesn’t want to see Obamacare repealed, and even suggested Trump may be on the verge of betraying her and others in the region:
“If he don’t come across like he promised, he’s not gonna be there next time. Not if I can help it.”
But what did Trump actually “promise”?
These coal country residents are not quite in the same situation as many of the law’s other beneficiaries, who are currently gaining access to health coverage due to increased federal spending and regulation. But they are all benefiting from increased governmental intervention under the law designed to expand health care and support to lower-income or sick people who were unable to secure it for themselves under the old system. Many of them would lose these benefits if the law is repealed.
There is some evidence that many of those people voted for Trump. The Wall Street Journal recently demonstrated that rural, aging, and working class counties that went overwhelmingly for Trump also showed large drops in the uninsured rate. Similarly, Gallup-Healthways data shows that among non-college, lower income whites — a Trump demographic — the uninsured rate has dropped 10 percentage points.
Now, obviously, many Trump voters may still not like the flawed aspects of Obamacare, even if it did expand coverage to a lot of them. And many Trump voters may have backed him because of his promise of jobs — which they’d prefer over government as their means to gaining health care.
But these coal country voters in the CNN segment were very clear: They don’t want to lose the protections Obamacare grants them. Other reporting has found similar worries in Trump country. Still other reporting has turned up examples of Trump voters who don’t actually believe he’ll take away their Obamacare.
So what did Trump really tell these voters?
Yes, Trump said endlessly that he’d do away with the ACA instantly. Yes, his own replacement plan would leave millions without coverage. But here’s the rub: Trump also went to great lengths to portray himself as ideologically different from most other Republicans on fundamental questions about the proper role of governmental intervention to help poor and sick people without sufficient access to medical care.
In January of 2015, Trump said he wanted “to try and help” lower income people get health care, even if it cost him the GOP nomination — signaling a core difference with the GOP on this moral imperative. During the primaries, Trump pointedly told fellow Republicans he would not allow people to “die on the street,” telegraphing that core difference once again. Trump also repeatedly vowed not to touch Medicare, explicitly holding this up as proof he is not ideologically aligned with Paul Ryan on the safety net. As David Leonhardt details, Trump repeatedly demonstrated an ideological willingness to embrace a role for government in expanding health care to, well, all Americans.
And so, if many Trump voters didn’t really believe they’d lose protections under President Trump, this was not a crazy calculation to make. Now, Trump and congressional Republicans may indeed end up rolling back protections for millions who voted for him. But if that happens, and these voters do end up feeling betrayed by Trump, they will be right to feel that way — they will, in fact, have been scammed by Trump.
Perhaps, like other scam victims, they should have looked more closely at the fine print. But the broad conclusion they reached was a perfectly reasonable one.