WASHINGTON ― If President Donald Trump and Republicans make good on their promise to angry rural voters to repeal and replace the Affordable Care Act, those voters may wind up a lot angrier.
And it won’t be good for their health or for the electoral prospects of the GOP.
Democrats, at least, certainly think so, and are looking at both fresh polling data and history for evidence that the GOP’s repeal and replace effort will also repeal Republican control of Congress.
For Jill Hanauer, who runs the progressive election research and strategy outfit Project New America, the landscape is starting to remind her of Colorado in 2004, when Democrats did especially well, running in part on a health care message.
“The way we really won in Republican-leaning districts of the state legislature was talking about the specifics of health care ― particularly breast cancer and prostate cancer and other cancer screenings and other prevention,” Hanauer recently told The Huffington Post. “Thirteen years later, those same issues are, I believe, going to tear this party potentially apart if they don’t smell the coffee.”
Two things back up Hanauer’s opinion. One is polling.
A survey her group commissioned with Myers Research delved into Nevada, where Republican Sen. Dean Heller faces a battle for re-election in 2018. First, the poll found Trump’s approval ratings are under water, at 42 percent positive versus 50 percent negative. Heller comes out even worse, at just 33 percent favorable and 53 percent unfavorable.
Rebecca Lambe, the senior Democratic strategist widely credited with engineering electoral success in Nevada under former Sen. Harry Reid, said the problem for Heller is that while voters still see Trump as someone they sent to Washington to shake up the system, Heller is part of that system.
“Nevada voters will not be giving Dean Heller that same benefit of the doubt they are offering to Trump, as they still see him as part of the problem in Washington,” Lambe said.
Hanauer pointed to findings from the survey that suggest voters will give Heller even less love if he helps carry out the repeal bid, especially if the Affordable Care Act, also known as Obamacare, is replaced by the proposal currently moving through the House of Representatives.
“Overwhelmingly, Nevada voters are supportive of the specific components of the ACA, with as many as 9-in-10 saying that any replacement should not turn back the clock on coverage and put insurance companies in charge again,” the analysis accompanying the polling data says.
The second thing that should worry Republicans, Hanauer and Democrats say, is the emerging reality of the GOP’s health care plan ― and the impact it will have on Trump voters.
The centrist group Third Way estimated in a report released Thursday that 2.2 million Trump voters will be worse off under Republican leaders’ proposed American Health Care Act. Many of those voters are rural and white.
Independent analysts see similar outcomes.
“Low-income people in rural areas would get hit particularly hard under the House GOP health care bill,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation.
One way rural voters get hit is through the fact that tax credits proposed under the Republican health care plan are not as generous as those under Obamacare. For instance, in the Reno, Nevada, market, a 60-year-old person who earns $40,000 would get almost $2,000 less to buy health insurance in 2020, a Kaiser Foundation analysis found. Nationally, the average cost hike for that person is nearly $3,000, and in some locales, such as Mobile, Alabama, the difference is an eye-popping $6,000.
Another way lower-income white voters could be hurt is by Medicaid cuts that harm rural hospitals, many of which are already on shaky ground. The bill aims to give states more flexibility in how hospitals spend Medicaid, but it also caps spending growth at a rate lower than the inflation index for health care.
“Flexibility is one thing, but when it comes with fewer dollars, that constrains the ability of states to provide coverage and adequate financial protection for hospitals,” Levitt said. And with fewer people able to afford insurance, such hospitals would likely face greater uncompensated expenses treating people who can’t pay.
“The way we really won in Republican-leaning districts of the state legislature was talking about the specifics of health care ... those same issues are, I believe, going to tear this party potentially apart if they don’t smell the coffee.””
- Jill Hanauer, Project New America
Democrats predict a grim future for the GOP in which voters will punish them for taking away things they like.
“This isn’t just unique to Nevada,” Hanauer said. “This is a Republican Party federal problem. Their voters voted to shake up Washington, not blow up government as we know it, certainly not blow up the key things voters care about.”
Heller is certainly aware of the danger in his state, and has not yet embraced the GOP plan, though he still rails against the Affordable Care Act.
“Obamacare is failing millions of Americans. Sen. Heller supports delivering more access, better benefits, and lower costs to Nevadans,” said Heller spokesman Neal Patel. “This bill is a little over two days old. It’s still working its way through the House. The senator will be monitoring it closely. He will continue to work with the Governor to advocate for Nevadans who depend on Medicaid, while also tackling the problems caused by Obamacare.”
Heller will probably have to do more than monitor closely. He may have to oppose his party, because many of his colleagues ― even ones who represent large rural populations ― are determined to proceed with the GOP’s repeal and replace plan.
Sen. John Kennedy (R-La.) told HuffPost that the Medicaid system and the expansion under Obamacare is already a failure, and that states would be able to do more with less ― in the form of block grants ― if they get more flexibility.
“If you continue to expand Medicaid, in my opinion, based on the model that we’re using now, you’re just putting paint on rotten wood,” Kennedy said.
He derided the attempts of Louisiana’s Democratic governor, John Bel Edwards, to embrace Obamacare.
“He believes in more free stuff. You can’t give him enough free stuff. As long as somebody else is paying for it, he’ll take a dozen of them,” Kennedy said. “I don’t mean any disrespect, but I’ve know John Bel for a long time. I’m not interested in more free stuff. We can’t afford more free stuff.”
There are signs Republicans are concerned about the downsides of following through with Obamacare repeal, however.
Four senators, including West Virginia Republican Shelley Moore Capito, signed a letter saying they would oppose anything that rolled back expanded Medicaid coverage in their states.
“I still have remaining questions, particularly on the Medicaid expansion side, but I feel like it’s gelling and we’re moving in a direction where those 184,000 people that I’ve been talking about are going to be able to stay insured and have a stable transition period,” Moore Capito told HuffPost.
But she still allowed that she has concerns. “I’m worried on any negativity that could obviously be more targeted towards a rural or older state because that is where I live and the folks I live with,” Moore Capito said.