House Republicans scared up enough votes to repeal Obamacare. Now, their voters in Michigan, Wisconsin, Kentucky—and throughout the Rustbelt—should prepare for disaster, because they will lose big if the bill becomes law.
The Affordable Care Act was a windfall for working-class white Americans who voted for Donald Trump. Because there are more of them, this group will lose more ground than blacks, Hispanics, and college-educated whites if Obamacare is repealed. Despite this, President Trump and fellow Republicans are moving forward with their reckless plan to lynch Obamacare before offering a viable replacement that does more good than harm.
If the GOP were replacing it with something better—perhaps a less costly alternative—while safeguarding opportunities that Trump voters now have under Obamacare, this would be a fitting way to repay their support. But there is a world of difference between promising a better health care law that works for everyone and actually delivering one. Trump voters, who cannot afford to forego coverage for pre-existing conditions, maternity and pediatric care, and emergency services, must insist upon seeing the goods before giving up their civil right to health care without a fight.
There is serious disagreement over whether Obamacare is a civil rights issue. Bernie Sanders says health care is a right, not a privilege. Kathleen Parker, a Pulitzer Prize-winning journalist for The Washington Post, argues that during the ‘60s the civil rights activists fought for freedom and that a government mandate to buy insurance is anything but that. Such critics say Obamacare is simply another case of big brother meddling with our freedom by forcing us to do something that may be right, or even good for us, but that we should ultimately have the freedom to decide.
But the civil rights movement—paid for with the blood, sweat, and tears of American heroes like Rep. John Lewis who did much more than talk and tweet about making America great—was never merely about freedom from government overreach, it was also equally about government affording citizens opportunities needed to take full advantage of their precious liberties.
“The struggle for rights,” as the most famous civil rights activist, Martin Luther King, Jr., once said, “is a struggle for opportunities.” This includes the opportunity to get a decent education and earn a living wage. It also includes the opportunity to have the government support necessary so that poor health is not an obstacle to exercising our freedom to pursue the American Dream.
America’s Health Rankings annual report documents why health insurance coverage is so vital. In states across the nation hardest hit by ill health effects such as Wisconsin, where 24.5 percent of adults report either binge or chronic drinking; Kentucky, where 34.6 percent of adults are obese with a body mass index of 30 or higher; and Michigan, where 20.7 percent of adults report smoking daily or frequently, the civil right to health care has given Trump voters the opportunity to get much needed care and medication for themselves and their families. Air pollution, childhood poverty, and infectious diseases are other contributors to poor health in these and other Red and Blue states.
If we take a broader perspective on civil rights, seeing this as a struggle for opportunity as well as freedom, the important questions are what opportunities have been gained under Obamacare, which Americans have gained them, and who stands to lose the most ground if this law is repealed. The evidence that working-class whites have made the largest gains in opportunity is striking.
A recent Urban Institute report found that between 2010 and 2015 whites made the largest gains in insurance coverage under the Affordable Care Act. 8.2 million whites went from being uninsured to insured compared to 2.8 million blacks and 6.2 million Hispanics.
Also, whites without college education—who overwhelmingly supported Trump—made big gains during this period. In 2010, 20 percent of this group lacked insurance and that number was nearly cut in half to 12.2 percent after five years, as 6.2 million working-class whites gained coverage.
A majority of the 18 million people estimated to lose health insurance in the first year if Obamacare is repealed but not replaced will be Trump voters. Because they have gained the most, they will be the biggest losers. A larger number of their white faces will crowd emergency rooms (never a good thing) without Obamacare, and they will receive the worst level of care at the greatest cost (ultimately passed on to all of us). Working-class whites will be the face of an unhealthy America.
Biting the hand that feeds you is never wise. So why would Trump and the GOP move to strip working-class whites of the right to get health care? Perhaps if they were more open to the idea that something good, useful, and smart can come from a black president they would endeavor to upgrade the nation to Obamacare 2.0 revising rather than repealing the ACA without a viable replacement that works for everyone. This would make health care opportunities even greater for Trump voters and other Americans.
This may be too much to ask now when our new leaders seem hell-bent on undoing Obama’s legacy, but the truth is that white Americans who supported Trump will be better off if Republicans replace Obamacare with a viable alternative before they repeal it.