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President Trump’s health-care plan probably would make health care pricier for core Trump voters

President Trump praises the House Republicans' plan to alter the Affordable Care Act, March 7, at the White House. (Video: The Washington Post)

President Trump offered his unqualified support for the Obamacare alternative that House Republicans announced Tuesday. “I’m proud to support the replacement plan released by the House of Representatives,” he told GOP lawmakers a few hours after he tweeted about “our wonderful new Healthcare Bill.” At his daily news briefing, White House press secretary Sean Spicer specifically said that the proposal was “the Obamacare replacement plan that everyone has been asking for, the plan that the president ran on.”

If this is the plan that Trump ran on, his voters might be surprised to hear it. Preliminary analysis suggests that Trump’s base of support is more likely to see insurance premium costs rise — often substantially — under Trump’s bill.

When we talk about the core of Trump’s support, we’re talking largely about white working-class voters. Nearly 9 in 10 Trump voters were white, and his support was larger among those who had lower incomes and were older.

Among white voters younger than 30, Trump won by four percentage points nationally, according to exit polling. Among those ages 45 to 64, he won by 28. Income worked in the reverse direction. Those making $250,000 or more a year backed Trump by five points. Those making $50,000 to $99,999 annually supported him by 28.

Shortly after the policy was announced, AARP sent a letter to congressional leaders offering the organization’s unqualified opposition to the policy as written.

“Affordability of both premiums and cost-sharing is critical to older Americans and their ability to obtain and access health care,” the letter reads. “A typical senior seeking coverage through an exchange has a median annual income of under $25,000 and already pays significant out-of-pocket costs for health care.” They offered estimates of how the Obamacare replacement bill might affect older Americans. (Note that the figures below relate to those seeking insurance on an exchange — that is, not through an employer.)

“We estimate that the bill’s changes to current law’s tax credits” — the subsidies provided by the government to reduce the cost of insurance — “could increase premium costs for a 55-year old earning $25,000 by more than $2,300 a year. For a 64-year old earning $25,000 that increase rises to more than $4,400 a year, and more than $5,800 for a 64-year old earning $15,000,” it says. That’s an increase of 9 percent of the 55-year-old’s annual income and 39 percent of the annual income of that 64-year-old earning 15,000 a year. When the analysts combined changes to the tax credits with a proposal to expand ratio of costs relative to younger recipients from 3 to 1 to 5 to 1, the figures were worse. In that case, “taken together, premiums for older adults could increase by as much as $3,600 for a 55-year old earning $25,000 a year, $7,000 for a 64-year old earning $25,000 a year and up to $8,400 for a 64-year old earning $15,000 a year.”

The Kaiser Family Foundation, which has been tracking the effects of the Affordable Care Act (Obamacare) since its inception, put together an interactive tool showing how tax credits might change. If you’re a 40-year-old making $75,000 a year, you’re going to get a 75 percent or higher increase to your tax credits — a beneficial situation for you.

If, however, you’re a 60-year-old making $30,000 a year, you’re going to see a reduction in those tax credits (unless you live in Upstate New York or Massachusetts or parts of central Texas).

Notice that Michigan, Pennsylvania and Wisconsin — states central to Trump’s electoral victory — are all blue on that map, showing that their credits will decrease. The map is by county, so the effects of population are harder to spot, but the general trend is clear. “Generally,” the Foundation writes, “people who are older, lower-income, or live in high-premium areas (like Alaska and Arizona) receive larger tax credits under the ACA than they would under the American Health Care Act replacement.”

Beyond the fact that voters more likely to have supported Trump are also more likely to see cost increases, there’s a political hazard here for everyone else, too. AARP, representing retirees, also represents the voting bloc most likely to head to the polls regularly, including in off-year elections. If the House plan presses forward, the negative effects could be weighted more heavily toward the people who will be most likely to vote in the November 2018 midterm elections. That, for obvious reasons, poses some hazards for Republican champions of the bill.

If the legislation’s first day in the wild is any indication, though, we can assume that the version that finally receives a vote on the House floor — assuming a version does — may look substantially different from the version being assessed at the moment. It has received a slew of negative responses from across the political spectrum, making it hard to see how the current bill could be passed.

At some point, too, Trump may want to set aside his desire to have a quick win on a “repeal” of Obamacare in favor of a policy that’s less likely to distribute the pain of the shift to his core base of support. The hallmark of Trump’s base has been its loyalty, with Trump once bragging that he could shoot someone dead in the middle of Fifth Avenue and his supporters would stick by him. Possibly. But they may be less forgiving if Trump signs a bill into law that negatively affects their own personal health, middle of the street or not.