Trump Counties Would See Big Impact From Obamacare Repeal
When he campaigned for president, Donald Trump made repealing and replacing the Affordable Care Act a signature issue. Polling suggests that such a move would have the biggest impacts on communities that gave Mr. Trump some of his highest levels of support, potentially complicating the politics of a repeal effort.
More than 20 million Americans now depend on the ACA, also known as Obamacare, for health insurance. Data from Gallup indicate that a lot of those people live in counties that favored Mr. Trump.
The Gallup data, analyzed with the county typology from the American Communities Project, show that eight county types have seen increases in health insurance coverage greater than the national average. Six of those types — representing about 77 million people or 33 million votes, a quarter of the total cast — sided with Mr. Trump, some by very large margins.
Some of the county categories listed in the table were particularly important to Mr. Trump. Swaths of largely rural Graying America, Rural Middle America and Working Class Country counties make up large parts of Florida, Michigan, Pennsylvania and Wisconsin, the states that led to Mr. Trump’s victory.
The fact that insurance coverage rates increased in those counties is not a surprise. They are the kinds of places that the ACA targeted when it aimed to expand coverage. The county categories that show big upticks in insurance coverage had been below the national average for coverage rates in 2008, according to Gallup data. Many of them have median incomes below the national average and struggle with higher than average unemployment rates.
Viewed through a political lens, the numbers suggest a challenge for Mr. Trump and the GOP-led Congress. If Mr. Trump keeps his campaign promise to scrap and replace the ACA, communities that gave him some of his biggest margins would likely see the biggest impact. That reality may be behind Mr. Trump’s expressed interest in holding onto at least parts of the law, particularly provisions that bar insurers from denying insurance on the basis of preexisting conditions and which allow people to keep their older children on parents’ plans.
At the same time, some people who gained insurance coverage may nevertheless dislike the law—among other reasons, because coverage was mandated. In other words, just because people follow a mandate doesn’t mean they necessarily support it.
Gallup’s data show that nationally, 53% disapprove of the law, while 42% approve of it. That’s despite the fact that the uninsured rate in the U.S. sank to 10.9% in the third quarter of 2016, according to Gallup. That’s the lowest since Gallup began tracking the figure nine years ago.
And there is the question of the law’s cost.
The Gallup survey data show that people living in some places that favored Mr. Trump’s election are likely to say there have been times in the last year when they did not have enough money for health care or medicine their family needed.
That was particularly true for those living in the African American South, Evangelical Hubs, Working Class County and Hispanic Centers, where 19% or more said that statement applied to them. Mr. Trump won three of those county types. Nationally, that figure was 15.6%.
People may say they don’t like the law or its costs, but what happens if changes to the law result in people losing coverage? That’s a question that probably can’t be answered until after the changes are made.
When the repeal and replacement of the ACA may happen is not yet clear. Some conservatives are saying the complexities of making such a big change take time, and that may mean waiting until perhaps 2019 to implement a replacement for the health law.
By that point the next presidential election will be much closer.
Next Article Previous Article