The Washington PostDemocracy Dies in Darkness

Opinion Yes, Trump scammed many of his working-class supporters. This new analysis leaves little doubt.

President Trump speaks about efforts to overhaul health care. He is expected to talk on that and other topics, in an address to a joint session of Congress (Video: Reuters, Photo: Bill O'Leary/Reuters)


Ever since President 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.

The GOP health-care plan isn’t about health care at all

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. This chart summarizes 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).

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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).

Republicans confirmed substance abuse and mental health coverage would no longer be mandated under the Medicaid expansion. (Video: Energy & Commerce Democrats)

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 non-elderly 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.

How did the GOP come up with this awful health-care bill?

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.


* WHITE HOUSE PRIVATELY PUSHES HEALTH BILL TO RIGHT: CNN scoops that the White House is privately urging House Republicans to make their bill phase out the Medicaid expansion even sooner, to make conservatives happy:

White House officials are beginning to urge House GOP leadership to include an earlier sunset of the Medicaid expansion funds authorized under Obamacare than the 2020 date set by the current bill … Ending the Medicaid expansion sooner could complicate prospects for the bill in the Senate. And it would likely infuriate Republican governors in states that accepted federal funds for the expansion.

If this does get into the GOP bill, it might make it much harder for GOP senators and governors from Medicaid expansion states to support the plan.

* TOM COTTON KEEPS HAMMERING GOP BILL: Sen. Tom Cotton (R-Ark.) keeps up his attacks on the GOP repeal-and-replace bill in an interview with The Post:

“The bill that was introduced Monday night cannot pass the Senate. And I don’t think it will be brought to the Senate for a vote … I can tell you a number if not a majority of Republican senators think that this process has been too breakneck, too slapdash, and they do not see a good solution for the American people coming out of the House bill as drafted.”

Cotton, remember, is a staunch ally of Trump, who badly wants the House bill at this point.

* ANALYSIS: GOP PLAN WILL MEAN HUGE COVERAGE LOSSES: The Brookings Institution looks at previous Congressional Budget Office analyses to estimate what CBO might say in its forthcoming analysis of the House GOP repeal-and-replace bill:

We conclude that CBO’s analysis will likely estimate that at least 15 million people will lose coverage under the American Health Care Act (AHCA) by the end of the ten-year scoring window. Estimates could be higher, but it’s is unlikely they will be significantly lower.

No wonder Republicans are preemptively trying to delegitimize the CBO’s finding. The question is whether this will lead more GOP senators, particularly from Medicaid expansion states, to bolt.

* HOW TRUMP IS PRIVATELY PUSHING REPUBLICANS: The New York Times reports on the various ways that Trump is pressing Republicans to back the GOP health bill. Note this description of a recent private meeting, from Rep. Patrick McHenry (R-N.C.):

“He made it clear that this is his priority, that it has to get done, and he made clear that he has to get it through before he moves on tax reform.”

Translation: Republicans, you have to give Trump his big victory in killing Obamacare before you get your tax cuts for the rich. Clever!

* KOCH BROTHERS’ GROUP STILL OPPOSED: Yahoo News reports that even after meeting with Trump, the head of the Koch-backed Americans for Prosperity still opposes the GOP bill:

One conservative leader at the meeting — Tim Phillips, president of Americans for Prosperity, which is backed by the Koch brothers — told Yahoo News that his group remains opposed to the health care proposal. AFP opposes a tax credit toward the purchase of health insurance, and the White House is not budging on that point, Phillips said.

It’s hard to say how many lawmakers will be swayed by this, but it certainly won’t help.

* WHY THE GOP BILL IS SO AWFUL: Paul Krugman points out that the GOP bill accepts the basic logic of Obamacare (subsidies and regulations plus a penalty for non-continuous coverage) yet weakens all of them in a fatal way. And here’s why:

Republicans seem to have been undone by their reverse-Robin-Hood urges. You can’t make something like Obamacare work without giving lower-income families enough support that insurance becomes affordable. But the modern G.O.P. always wants to comfort the comfortable and afflict the afflicted; so the bill ends up throwing away the taxes on the rich that help pay for subsidies, and redirects the subsidies themselves away from those who need them to those who don’t.

Amazing how often it all comes back to that zeal to cut taxes on the rich, isn’t it?

* A GOOD JOBS REPORT: The economy added some 235,000 jobs in February, and the unemployment rate ticked down to 4.7 percent. This, from economist Justin Wolfers, seems like a balanced take on the news:

Something tells us Trump will suddenly decide the jobs numbers aren’t Fake News.

* BUT TRUMP CAN’T STOP DISSEMBLING ABOUT ‘SAVED’ JOBS: Michelle Ye Hee Lee has a comprehensive analysis of many of Trump’s efforts to take credit for jobs “saved,” and it turns out most of them are largely nonsense:

Trump’s bravado on these jobs announcements is becoming a bad joke. He claims credit when little or no credit is due to his policies. Moreover, he is counting these jobs as jobs in the bank, when corporate plans frequently change according to market or economic forces. Trump has promised to create 10 million jobs over the next four years, and that ultimately is what he will be judged on.

And remember, it’s in the interests of corporate leaders to play along with Trump’s claims. One hopes voters actually do judge him on his concrete promises, rather than on these stunts.