Why Republican voters seem to vote against their own best interest has long been a liberal’s conundrum. When Trump won the 2016 Presidential election, many liberals outspokenly wondered, “Why would Republicans elect a President whose policies challenge their best interests?” But perhaps they should instead be asking why so many of these Americans were drawn to a man like Donald Trump, despite the fact that his policies challenge their best interest.
No clearer can this question be surveyed than in the case of the Affordable Care Act.
Throughout his campaign, Donald Trump vowed to get rid of “ObamaCare” and replace it with “something terrific, something great.” This campaign promise was critical to the success of his Republican presidential candidacy, and subsequently he repeated it on his first day in office. With his victory, it seemed clear that dismantling Obama’s greatest domestic policy achievement was of utmost priority in the minds of America’s Republicans.
However, the call for repeal proved stronger in theory than in actuality. On July 28th, after repetitious failures to repeal ObamaCare, Republicans staged their final hurrah–a “skinny repeal” that lacked nearly all the political toxin of their previous attempts. However, Republicans John McCain, Lisa Murkowski and Susan Collins joined the Democrats in voting down the proposed law. When the law died in the Senate, it seemed to die to the public as well. The very people who had chanted alongside Trump became hesitant of his promise to repeal their health care system. A video of a man changing his mind and calling for the continuation of ACA circled the internet; The New York Times interviewed a man, Mr. Brahin, who said “As much as I was against it, at this point I’m against the repeal. Now that you’ve insured an additional 20 million people, you can’t just take the insurance away from these people,” he added. In fact, according to a poll tracked by PollingReport, which The Washington Post compiled starting in March, on average, only 22 percent of Americans supported GOP proposals to replace the ACA.
What became clear in the weeks during the Republican’s attempt to repeal the ACA is that the majority of Republicans did not originally vote against the law itself; they voted against President Obama and a government they felt no longer represented them.
According to a study by the Kaiser Family Foundation, focusing specifically on Republicans, when asked the main reason why they have an unfavorable view of the health care law, about three in ten said it is because they believe the law gives government too big a role in the health care system (31 percent) or say it is just one of many indications that President Obama took the country in the wrong direction (27 percent). This reaction to the ACA is a mirror into the way politics is organized today. Policies do not drive opinions, culture does. The majority of Republicans had an unfavorable view of Obama’s ACA, precisely because it was Obama’s ACA; it was the Democrat’s ACA; it was not their ACA.
Yet, logistically it was. In 1993, the Clintons sought to reform health care. In response, Republicans scrambled to introduce their own health care bill. The Heritage Foundation, forefather of right wing think tanks, with Republican Sen. John Chafee of Rhode Island leading, proposed the Health Equity and Access Reform Today, which is argued to be nearly identical to the ACA. Both bills proposed an individual mandate, the creation of purchasing pools, standardized benefits, vouchers for the poor to buy insurance and a ban on denying coverage based on a pre-existing condition. While the bill never came into being, it represented a similarity between the logistics of Republican and Democratic health care ideals. Further, Obama himself has credited Romneycare as a foundation for ObamaCare. And Romney was quoted saying, “without Romneycare, I don’t think we would have Obamacare.” Substantively, the ACA could very well be the GOP’s bill, if it was not tainted with “Obama.”
To boot, if Republicans were to vote according to their own best interest when it came to health care, the statistics say they would most likely support the ACA.
Roughly 20 million people have gained coverage through the Affordable Care Act, Democrats and Republicans alike. In fact, the parts of the country that lean the most heavily Republican showed significantly more insurance gains than places where voters lean strongly Democratic. Florida and Texas, two Republican leaning states, saw about 3.3 million people gain coverage as statewide uninsured rates fell 36 percent and 27 percent, respectively.
Yet, only 3% of Republicans said it benefited themselves or their families.
Of the 11.5 million Marketplace enrollees nationally, 6.3 million live in Republican districts and 5.2 million live in Democratic districts.
To understand the disparity between the law’s success and its approval rating among Republicans, take a closer look at Florida, a hot spot for curious political perplexities. Three congressional districts – all represented by Republicans – have among the highest number of Affordable Care Act enrollees in the country. Yet, irony prevailed when only nine House Republicans, none from Florida, dissented from the near party line 227-198 vote to repeal the ACA.
Republican Ileana Ros-Lehtinen, who has outspokenly favored the ACA’s repeal and replacement, heads Florida’s District 27. In 2013, she called the law’s implementation “bungled” and “not the answer for America’s health care system.” Her district enrolls 96,300 people, the highest number in the country, according to estimates by the Kaiser Family Foundation. Florida’s 26th district, led by Rep. Carlos Curbelo follows close behind with 92,500.
If the Republican’s plan to repeal the ACA were to actualize, nearly 200,000 people in these Republican districts would lose health insurance.
The inconsistency continues as, according to The Census Bureau, people who live outside metropolitan statistical areas have the highest rates of government coverage, at 42.7%. Yet, in the 2016 election Donald Trump won the presidency with a vast majority of support from those outside of metropolitan statistical areas, areas incongruously occupied by both ACA enrollees and Trump supporters.
Further, the populations with no high school diploma are the most likely to have government coverage (35.2 percent) compared with high school graduates (24.8 percent) and people with a bachelor’s or graduate or professional degree (11.2 percent and 9.4 percent, respectively). Looking at the 2016 election, it appears that educational levels were crucial in predicting who would vote toward one candidate or the other. According to a statistical presentation by FiveThirtyEight, it was the least educated states that won Donald Trump the presidency, especially given that a fair number of them are in swing states such as Ohio and North Carolina.
More recently, Politico explored the repercussions of Trump’s decision to withdraw America from the Trans-Pacific Partnership on rural America.
What the statistics tell us is that less education and living in rural areas means both a higher percentage of ACA enrollees and a higher percentage of Trump supporters. Given these statistics, why did Republicans vote for a President who ran on the promise that he would essentially take away their health insurance?
Perhaps the same reason liberals do–a higher motivation than self-interest. Liberals tend to support higher taxes. And these foundational ideals usually do not sway whether or not the policy negatively affects them. According to a survey by CNBC, eighty-six percent of Democratic millionaires said inequality is a problem, compared with only 20 percent of Republicans. Democratic millionaires were far more supportive of taxing the rich and raising the minimum wage. Among those who say inequality is a problem, 78 percent of Democrats support higher taxes on the wealthy, and 77 percent back a higher minimum wage. The same goes for liberals’ support of affirmative action, when it does not directly further their best interest.
While it is possible that Republicans do not know the substance of the policies they reject, as we saw with Tomi Lahren admitting her use of the ACA despite her being its biggest adversary, it is also possible that when voting, Democrats and Republicans have different priorities. Republican’s do not prioritize health care the way Democrats do but instead put their energy into the military, taxes, and terrorism. While Republicans lose the most materially by supporting Trump and his repeal of the ACA, they gain a sort of cultural power or at the very least cultural recognition.
The fight for many Republicans, it seems, is not to pinpoint the best policies but to live in an America that they recognize and that recognizes them. While this mindset begs for sympathy, it also demands concern. Republicans should not use health care as an emblem of their partisan ambitions because the cost is too high.