Some places that put Trump over the top could be most harmed by repealing Obamacare

logoBy Philip Bump

With Donald Trump headed to the White House, Republicans on Capitol Hill are poised to move quickly on rolling back Obamacare. On “60 Minutes,” House Speaker Paul Ryan said that changes to the Affordable Care Act will be “the first bill we’re going to be working on” in the next Congress.

Trump’s headed to the White House thanks to 80,000 voters in Michigan, Wisconsin and Pennsylvania — the margins of victory in three states he flipped from blue to red. He flipped other states, too, including Iowa and Ohio. The counties that moved to the right the most relative to 2012 were heavily (but not exclusively) across Appalachia, the Rust Belt and the upper Midwest.

The irony of Trump’s victory is that many of those counties also had the biggest increases in insurance rates under Obamacare.

Nationally, there’s no correlation between the change in insurance coverage in a county and the results of the 2016 election. But it’s certainly the case that much of the swath of states around the Great Lakes that went for Trump in 2016 also had big decreases in the number of uninsured since 2013.

Here is the number of uninsured in each county in 2013, according to data compiled by Enroll America and Civis Analytics.

The darker the county, the greater the density of uninsured people.

Now, here’s 2016.

We can view the change with a simple animation …

… or, better, by plotting it on a map.

Wisconsin is an exception to the rule. But in counties in Michigan, Illinois, Ohio and Pennsylvania — not to mention Kentucky, Arkansas and West Virginia — the shift in the number of uninsured was dramatic.  In West Virginia, 12 counties were in the top quintile of support for Trump and for reduction in the number of uninsured. In Kentucky, 34 were.

In counties that flipped parties after decades of consistent voting, the likelihood of shifting to Trump was directly correlated to the density of white voters without college degrees.

As The Post’s Greg Sargent noted last month, working-class white voters also saw a big drop in the population of uninsured under Obamacare, going from 25 percent in 2013 to 15 percent this year. Part of that was thanks to the expansion of Medicaid that was part of the Affordable Care Act’s expansions.

It’s not yet clear what an Obamacare repeal (and eventual replace) might look like, meaning that we can’t assume that the map will revert to the 2013 version. We can assume, though, that the map will shift back somewhat, meaning that those places that had the biggest changes in coverage are likely to see larger increases in the number of uninsured.

In many cases, those shifts will occur in places that voted for it to happen.

Philip Bump writes about politics for Washington Post’s The Fix. He is based in New York City.

Follow @pbump

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