Sen. Shelley Moore Capito (R-W.Va.) at the Republican National Convention in July. (Jeff Swensen/Getty Images)
Opinion writer

If you want to find quintessential President Trump voters, you would do well to look to West Virginia, where his promised restoration of the coal industry epitomized his nationalistic and populist appeal to white working-class voters. What would happen under the Senate’s health-care bill?

Sen. Shelley Moore Capito will be looking at a variety of factors. As a poor state, West Virginia, has benefited greatly from Obamacare:

Between 2013 and 2014, the number of uninsured individuals in West Virginia fell by 38.8 percent. Meanwhile, as one of the states that expanded Medicaid, West Virginia saw annual enrollment in the program rise by 34.3 percent. In addition, about 31,000 individuals purchased insurance on the state’s new health insurance exchange.

Between 2013 and 2014, the number of people without health insurance nationwide declined by 18.8 percent. The law’s effects on premium rates have been less clear. For instance, a study by PricewaterhouseCoopers found an increase of over 5 percent for premiums in the individual market between 2014 and 2015, while a study by the Commonwealth Fund found no change.

West Virginia has also suffered tremendously from the opioid abuse epidemic. The Post reported in March:

Deaths in West Virginia have overwhelmed a state program providing burial assistance for needy families for at least the fifth year in a row, causing the program to be nearly out of money four months before the end of the fiscal year, according to the state’s Department of Health and Human Resources (DHHR). Funeral directors in West Virginia say the state’s drug overdose epidemic, the worst in the nation, is partly to blame.

West Virginia’s indigent burial program, which budgets about $2 million a year for funeral financial assistance, had already been under pressure from the aging of the baby-boom generation. The program offers an average of $1,250 to help cover funeral expenses for families who can’t otherwise afford them.

Nationwide, hundreds of thousands of people are getting treated for opioid abuse through Medicaid. (“1.29 million people are receiving treatment for substance use disorders or mental illnesses thanks to the Medicaid expansion, according to research conducted by Harvard Medical School Health Economics professor Richard Frank and New York University dean Sherry Glied. About 220,000 of those people are receiving treatment for opioid abuse,” Business Insider reports.) Curtail Medicaid and a state like West Virginia won’t be able to treat as many people as well as it does now — and that’s not even preventing the graveyards from filling up.

Because West Virginia benefited so greatly from the Affordable Care Act, losing some of those gains (e.g., Medicaid access) would come at an extreme cost. (One study found that “states that achieved double-digit reductions in their uninsured rate for working-age adults between 2013 to 2015—Arkansas, California, Kentucky, Nevada, New Mexico, Oregon, Rhode Island, Washington, and West Virginia—all had expanded Medicaid as soon as federal resources became available in 2014.”)

Capito put out a statement vowing to examine the bill closely “using several factors to evaluate whether it provides access to affordable health care for West Virginians, including those on the Medicaid expansion and those struggling with drug addiction.” We think on the merits she will have a hard time disputing the conclusion that it will hit her state — hard.