With a Republican Congress and president set to be seated in 2017, it’s a good bet that all the coverage gains of Obamacare will be rolled back. Paul Ryan has been open about his desire to dismantle every piece of safety-net legislation since the Great Society, and it’s likely that he’s going to get his wish. That’s very bad news for the residents of depressed Clay County, Kentucky:
For Freida Lockaby, an unemployed 56-year-old woman who lives with her dog in an aging mobile home in Manchester, Ky., one of America’s poorest places, the Affordable Care Act was life altering.
The law allowed Kentucky to expand Medicaid in 2014 and made Lockaby โ along with 440,000 other low-income state residents โ newly eligible for free health care under the state-federal insurance program. Enrollment gave Lockaby her first insurance in 11 years.
“It’s been a godsend to me,” said the former Ohio school custodian who moved to Kentucky a decade ago.
Lockaby finally got treated for a thyroid disorder that had left her so exhausted she’d almost taken root in her living room chair. Cataract surgery let her see clearly again. A carpal tunnel operation on her left hand eased her pain and helped her sleep better. Daily medications brought her high blood pressure and elevated cholesterol level under control.
As stories like this one show, Obamacare has been a lifesaving boon to the rural poor – not just because of the exchanges, but especially because it expanded Medicaid coverage for low-income people. The need is staggering: in Clay County, one-fifth of the residents are disabled, almost 40% live in poverty, and 60% are covered by Medicaid. Thanks to Obamacare, the number of uninsured people living here has fallen by two-thirds. But all those gains are now on the brink of being undone.
All of this is true. But there’s one important fact that the NPR article chose not to mention: in Clay County, 86% of the population voted for Donald Trump, who promised to repeal Obamacare. (He also won big in the primary.)
This isn’t a fluke, but a well-established pattern. Kentucky and other poor, rural red states have a long history of voting for politicians who promise to inflict pain on them. As the article points out, Kentucky also elected a Republican governor, Matt Bevin, who immediately set about disassembling Kynect, the hugely successful health-insurance exchange established under Obamacare.
We’ve also seen this in Kansas, where conservative control has created an economy so dismal that Gov. Sam Brownback canceled a quarterly state economic report that showed just how bad things had gotten; and South Carolina, where a dysfunctional and underfunded state government has resulted in failing schools, crumbling roads and collapsing dams.
Places like Clay County flatly disprove the idea that “economic anxiety” is driving poor, white, rural voters in 2016, and that the solution is for the Democrats to reject “identity politics” and become more “populist“. On paper, it makes sense: These people are economically insecure. They do have every reason to be anxious and fearful. They should want more populism and a stronger social safety net.
But that’s not how they actually behave. Given the first chance, they leap to vote for politicians who’ll kick them in the teeth, just as long as they uphold America’s racial hierarchies as part of the bargain. They want nothing to do with progressives whose legislation has been such an enormous help to them. It’s only now, when they’ve got what they voted for, that they’re fearful the politicians they elected are going to take away their desperately needed health care.
I’m not proud of this, but honesty demands I acknowledge it: when I hear that poor people who voted for Trump might lose their health insurance and are afraid, some part of me whispers, “Good!”
Really, can you blame me for being upset? The liberal effort to bring universal healthcare to America was the biggest political fight and the hardest-won victory in decades. We progressives fought and struggled, marched and organized, lobbied and whipped votes. We overcame conservative brick-wall opposition, fought off a blizzard of litigation, and defended our achievement in the face of endless assaults and ludicrous lies. But it turns out that millions of the people we helped didn’t feel so much as a flicker of gratitude. At their first opportunity, they spurned this gift and voted for a burn-it-to-the-ground candidate.
Like I said, I have to acknowledge these thoughts, but I’m not proud of them. I don’t think it’s a good habit to cultivate uncompassion for other human beings, however deplorable their choices. And, of course, people who didn’t vote for Trump and the Republicans stand to lose just as much. It’s not their fault how their neighbors voted.
But I can’t entirely deny that there’s justice to it. People who value racial hierarchy and white supremacy even more than their own health and well-being are getting exactly what they wanted. If they’re taken aback when the consequences of that vote fall on their heads, they only have themselves to blame. Maybe that’s what it will take to make them realize that their priorities were wrong, and that they wouldn’t actually want to live in the world their own political beliefs are pointing towards.