House Republicans appear poised to approve the American Health Care Act, a bill that promises to overhaul Obamacare substantially with uncertain long-term effects.
One effect that we can predict, however, is that the brunt of the negative aspects of the bill — higher premium costs, weakened insurance plans for those with preexisting conditions and decreases in coverage — will be borne heavily by states that voted for Donald Trump, the president who would sign it into law.
There’s no real difference between red and blue states in terms of who is enrolled in the insurance marketplaces established under the Affordable Care Act (that is, Obamacare). The highest percentage of the population that’s enrolled is in Florida, one of the purplest states around. (The data here are from the Kaiser Family Foundation.)
But since the AHCA would introduce a flat subsidy to offset the costs of health coverage, older and poorer Americans would be disproportionately affected. And, as we noted in March (when the AHCA was first introduced), the jump in costs would affect red states more severely. If we compare the expected average decrease in subsidies in each state, according to the Center on Budget and Policy Priorities, with the 2016 vote in each state, there’s a clear trend.
Alaska sort of breaks the scale here, given the plunge in tax credits that residents can expect to see. But setting Alaska aside, the average decrease in subsidies in red states will be more than twice the average decrease in blue states.
What’s more, the effects by county will be about the same. Across the board, regardless of income (at left) or age bracket, counties that backed Trump will see a bigger reduction in subsidies than those that voted for Hillary Clinton — until you get to those who make $75,000 or more a year.
This is important for a critical reason: The Congressional Budget Office anticipates that increases in insurance costs — inevitable if subsidies decline — will eventually price people out of buying coverage. A big chunk of the expected drop in the number of people covered will come from people deciding that they simply can’t afford coverage any more.
To cobble together enough votes to ensure passage of the AHCA the Republicans embraced an amendment that would allow states to apply for waivers that let insurers change rates for those with preexisting conditions. This, too, could put residents of red states at disproportionate risk — both because there’s a correlation between support for Trump and the density of the population with preexisting conditions, and because politically redder states are more likely to use the opportunity to apply for such a waiver.
One exception to this pattern is in the AHCA’s proposed cuts to Medicaid. Since the Medicaid expansion that covered millions of Americans was more heavily adopted in blue states, those states would see more of an effect.
Otherwise, the bill affects Republican states more heavily than Democratic ones. This appears to be a side effect that House Republicans are prepared to accept.