The Impact of House GOP Health Care Efforts on Trump Voters
Would President Trump have lost the election if voters knew what the GOP actually had planned for Obamacare? In 2016, voters had to take Donald Trump at his word that he would replace Obamacare with something better. He did not offer a specific proposal during the campaign, but now the House Republican leadership has a concrete proposal. Under their legislation, health care coverage for many Americans will be worse than under Obamacare.1 But how much worse?
Third Way estimates that 2.2 million low-to-moderate-income Trump voters would lose the financial assistance for their health care coverage, which they receive today from Obamacare.2 The large group of Trump voters hurt by the GOP plan exceeds Trump’s margin of victory in key states.
This memo explains how the House GOP health care plan will affect Trump voters, presents estimates of the number of Trump voters affected in each state, and shows how the number of Americans hurt by the plan compares to Trump’s margin of victory in closely fought states.
The House GOP Health Plan
The House GOP health plan would affect low-to-moderate-income Trump voters in three ways:
- Reduced tax credit for health insurance premiums. Like Obamacare, the House GOP have called for a tax credit to buy health insurance for people who don’t have coverage through an employer or elsewhere. Unlike the Obamacare tax credit (which varies by several factors like age, income, and geography), the House GOP tax credit would vary by age. It would also decline in value for people with high incomes. Overall, the House GOP tax credit would be worth less to people with a lower-than-average income than the Obamacare tax credit.3
- Elimination of the cost-sharing subsidy. The House GOP have called for eliminating in 2020 the Obamacare cost-sharing reduction subsidy, which covers deductibles and copayments for low-to-moderate-income people (earning between 100% and 250% of poverty). The loss of this subsidy, plus the reduced premium tax credit, would make health care coverage unaffordable for low-to-moderate-income families, which means they would have to pay more than 10% of their income toward health insurance.
- Cuts to the Medicaid expansion. The House GOP have also called for phasing out the extra funding (known as an enhanced match rate) that Obamacare provides to states that have expanded Medicaid coverage for adults earning up to 138% of poverty. That provision would have an immediate impact on eight states.4 Those states expanded Medicaid with a contingency that, should Congress cut the extra funding, the expansion would be automatically eliminated. In addition, other states would likely eliminate or reduce the expansion due to the cuts.
Impact on Trump Voters
Third Way estimates that 2.2 million Trump voters would no longer have affordable health care coverage under the GOP health plan. This estimate is based on the likelihood of a Trump voter receiving assistance with coverage under either Obamacare’s expansion of Medicaid or a cost-sharing subsidy.5
Since Trump voters have a different demographic characteristic from Obamacare beneficiaries, we analyzed Trump voters by all available demographic characteristics—sex, race/ethnicity, and income—using exit poll data. For example:
- 47% of Trump voters were white males, which equals 29,387,636 Americans.
- 72% of white males have an income under $50,000, which is the cut-off level to qualify for the cost-sharing subsidy for a family of three.
- That leaves 21,304,363 (72% of 29,387,636) white, male Trump voters who could potentially receive assistance under Obamacare.
- Of the total voting-age population, 3.1% of white males over 18 years old are likely to actually receive a cost-sharing subsidy, according to data from the Department of Health and Human Services.
- That means 663,674 white males are likely to be Trump voters receiving the cost-sharing subsidy (3.1% of 21,304,363).
For each state, the number of Trump voters who will be hurt by the GOP plan is calculated the same way. For example, in Michigan with 2,153,651 low-to-moderate-income Trump voters, 2.3%, or 48,974, are likely to receive a cost-sharing subsidy. (See chart below.)
For the impact on Trump voters who are benefitting from the Medicaid expansion, we made a similar calculation based on demographic comparisons. Our estimate is limited to the eight states with automatic elimination of the Medicaid expansion in the event of the loss of extra federal funding. Additional states would likely cut their expansions due to GOP plan, but it is difficult to predict by how much. In Michigan, which is one of those eight states, we estimate that 140,213 Trump voters would lose their Medicaid coverage which, when combined with the 48,974 people noted above, equals a total of 189,332 Trump voters hurt by the initial version of the GOP House health plan.
Trump Voters Hurt by GOP vs. Margin of Trump’s Victory
Had Trump voters known they would be hurt by the GOP House health care plan, would they have still voted for Trump? That is impossible to know, of course, but their numbers exceed the number of votes by which Trump won in a number of closely fought states as shown in the chart below. Had these states flipped to the Clinton column, she would have won the election by 307 to 231 electoral votes.
Number of Trump Voters Affected in Key Election States
|State||Number of Trump votes over Clinton votes||Number of Trump voters hurt by GOP House health plan|
|Michigan (16 electoral votes)||10,704||189,332|
|Florida (29 electoral votes)||112,911||301,304|
|Pennsylvania (20 electoral votes)||44,292||53,526|
|Wisconsin (10 electoral votes)||22,748||34,991|
Number of Trump Voters Hurt by House GOP Health Plan
Victoria Chen contributed to this report.
United States, Congress, Committee on Ways and Means, “Republicans Release Legislation to Repeal and Replace Obamacare,” Press Release, March 6, 2017. Accessed March 7, 2017. Available at: https://waysandmeans.house.gov/american-health-care-act/.
Author’s calculations based on United States, Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, "Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report" State Level Data Tables, March 11, 2016. Accessed March 3, 2017. Available at: https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report. See also United States, Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, "Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report," Issue Brief, pp. 24, March 11, 2016. Accessed March 3, 2017. Available at: https://aspe.hhs.gov/system/files/pdf/187866/Finalenrollment2016.pdf. See also "Fox News Exit Polls," Poll, Edison Research, Fox News, November 8, 2016, Accessed March 3, 2017. Available at: http://www.foxnews.com/politics/elections/2016/exit-polls. Details of analysis are available upon request.
This analysis assumes that the total federal cost of the tax credit in the House GOP health plan would be no greater than the Obamacare tax credit on average and that the average cost of each would be the same. Under that assumption, tax credit recipients under the GOP plan with less than average income would receive less assistance from the tax credit than under the Obamacare tax credit.
“Eight States Will Stop Medicaid Expansion if Congress Reduces FMAP,” Inside Health Policy, Accessed February 21, 2017. Available at: https://insidehealthpolicy.com/daily-news/eight-states-will-stop-medicaid-expansion-if-congress-reduces-fmap.
While this analysis uses demographic data to estimate whether voters who receive financial assistance for coverage through the ACA likely supported Trump, it assumes those voters were evenly distributed between Clinton and Trump. There is no data available beyond the demographic tendencies to support one candidate or the other to determine how the receipt of assistance might have swayed their vote.