The Scrambled Politics of the Health Care Debate
Analysis shows House GOP plan would disproportionately hurt Trump strongholds, benefit liberal voters
A senator from New York in 1828 is credited with coining a famous term applying to the victory of one of President Donald Trump’s favorite predecessors, Andrew Jackson: “To the victors belong the spoils.”
The health care bill developed by House Republican leaders and endorsed by Trump, however, turns that phrase on its head. According to an analysis by the Kaiser Family Foundation, the American Health Care Act is more generous to younger people and residents in liberal-leaning states. Those are groups that disproportionately favor Democrats.
“These would be exactly the kinds of place that would lost the most, it would appear.”
At the same time, older Americans who have not yet reached retirement age and voters in lower-income states would be hit harder. They skew more Republican in general and form the heart of Trump’s base in particular.
In West Virginia, for instance, the Kaiser analysis projects that after applying the tax credits in the House plan, 27-, 40- and 60-year-olds at five different income levels would pay more for health insurance than they do under the Affordable Care Act in almost every county. The same is true for Kentucky. Christopher Devine, a political science professor at the University of Dayton in Ohio, noted that Trump won overwhelmingly in both states in the 2016 election.
“These would be exactly the kinds of place that would lose the most, it would appear,” he said.
Meanwhile, 27-year-olds making $20,000 or $30,000 a year would do better in many places — and disproportionately in states and counties that backed Democrat Hillary Clinton. For instance, 27-year-olds making $30,000 a year would pay less in most of Washington State, the coastal areas of Oregon, Southern California, and most of New England.
Not only are those Democratic strongholds, but the age demographic is a weak one in general for the GOP. Exit polls indicated that Clinton beat Trump among voters younger than 30 by 19 points.
Trump-State Residents Worse Off
It works in the other direction, too; 27-year-olds making $30,000 would pay more in Alabama, North Carolina, Wyoming, North Dakota, most of Montana, much of Texas and all but one county in Arizona. Those were all Trump states.
There is a politically odd split within some states, too. In Colorado, for instance, 27-year-olds of modest income wold pay less in counties in and around Denver that generally went for Clinton. Their counterparts in rural counties in the western and eastern parts of the state — disproportionately Trump country — would pay more.
The same general split shows up in Georgia, where residents of Atlanta and its surrounding counties — which favored Clinton — would get a break, while Trump-voting counties in southern and northeastern Georgia would fare worse under the Republican bill.
Not that Republicans are getting any gratitude from the elected representatives of those Democratic-leaning voters who would be winners.
“It’s an irony of irony that the place that this most affects is the heart of red Trump vote areas, rural areas,” Senate Minority Leader Chuck Schumer (D-N.Y.) told reporters after the Congressional Budget Office forecast last week that 24 million fewer Americans under the proposal would have health insurance in fiscal year 2026 than under current law. “Rural areas, poorer areas, in many of the red states are most affected.”
House Minority Leader Nancy Pelosi (D-Calif.) said at the same news conference that much of the benefit created by the bill would go to blue areas.
“It’s not right,” she said. “But think of yourself as a Trump voter in West Virginia or someplace, or Kentucky, which has really done a good job … ‘Is that what I voted for?’ I don’t think so.”
Republican leaders seem to recognize the inconvenient politics. House Speaker Paul Ryan (R-Wis.) authorized changes in the bill that will come up for a vote Thursday. It makes it easier for the Senate to add more benefits for older health care customers.
Economic Justification Cited
The politics notwithstanding, health care experts said there are good economic reasons behind the overhaul. One of the failures of Obamacare, they say, is that did not attract enough young and healthy customers to balance older and sicker patients. The law prohibits insurers from charging older people more than three times as much as young customers. The Republican bill would change the ratio to 5-1.
“You want to design a plan to make the risk pool healthier and make it stable,” said Drew Gonshorowski, senior policy analyst at The Heritage Foundation. “The ACA redistributed risk from the older people into the younger population.”
Robert Graboyes, a senior researcher at George Mason University’s libertarian-oriented Mercatus Center, said Obamacare was a wealth transfer from the middle class to lower-income people.
“To a large extent, what this does is it reverse that flow,” he said.
Graboyes said the new proposal rearranges government spending without attacking the root cause of costly health care.
“It falls into the same trap as the Affordable Care Act, which is, it’s about distribution of benefits,” he said.
Graboyes said tax credits are simpler than Obamacare’s subsidies, which require people to predict what their income will be in the coming year. But he said it maintains as much government involvement in health care. A system of fewer government mandates and regulations would allow the market to reduce prices as it does with other goods and services, he said.
He compared it to the government’s largely hands-off approach to cellphones. That resulted in an amazing transformation from 25 years ago — when Graboyes said he knew exactly one person with a cellphone — until now, when there is, to borrow a phrase from the health care debate, “universal coverage.”
Grace-Marie Turner, president of the Galen Institute, said she is confident that the American Health Care Act will introduce more freedom into the market and reduce prices.
“People want health insurance … but they want to be able to afford it,” she said.