Trump supporters have the most to lose from TrumpCare (a bunch of broken Trump promises)

Remember when Donald Trump promised that “We’re going to have insurance for everybody”, and his sycophant supporters believed this grifter and con man? Of course he lied to his supporters to get elected.  You’ve been played.

Nate Cohn explains Why Trump Supporters Have the Most to Lose With the G.O.P. Repeal Bill:

The people who stand to lose the most in tax credits under the House Republican health plan tended to support Donald J. Trump over Hillary Clinton in the 2016 election, according to a new Upshot analysis.

Over all, voters who would be eligible for a tax credit that would be at least $1,000 smaller than the subsidy they’re eligible for under Obamacare supported Mr. Trump over Hillary Clinton by a seven-point margin.

The voters hit the hardest — eligible for at least $5,000 less in tax credits under the Republican plan — supported Mr. Trump by a margin of 59 percent to 36 percent.

These estimates are based on data from the Kaiser Family Foundation and the Cooperative Congressional Election Study (C.C.E.S.), a large survey of tens of thousands of Americans. Kaiser estimated whether individuals would gain or lose under the Republican plan to replace the Affordable Care Act, based on their income, age and insurance market.

We matched the data to the C.C.E.S.’s postelection survey, which asked individuals about their health care and how they voted in the 2016 presidential election. The end result: an estimate for how much every respondent of the survey would gain or lose under the Republican plan, based on age, income and county.

Like any result based on a survey, the estimates are imperfect. But the Republican plan offers less assistance to older and lower-income Americans, especially in rural areas, according to the Kaiser data. These groups generally backed Mr. Trump. Most of all, President Trump’s white working-class supporters often make enough money to be ineligible for Medicaid, but not enough to afford costly health insurance that might even become more expensive under the Republican plan.

The plan would hit older and rural Americans hardest because it wouldn’t provide a larger tax credit to people with more expensive plans. Older Americans pay the highest premiums, and the law would allow insurers to raise premiums for older customers even further.The AARP opposes the bill as a result.

Rural areas often have higher premiums because there’s less competition. Residents in those areas would receive the same subsidy as people in cheaper markets.

This analysis is limited to people who don’t receive Medicare or Medicaid. But Medicaid recipients, who also stand to lose under the law, lean more Democratic. Nationwide, Medicaid recipients supported Mrs. Clinton by a margin of 55 percent to 39 percent, according to the C.C.E.S. data.

The effects of the Republican plan on Medicaid recipients are less clear. Many of them might lose their Medicaid coverage or see their benefits pared back as a result of the bill.

The law would reduce funding for a major expansion of the Medicaid program for poor Americans in more than 30 states and cut future Medicaid funding across the country. Most of those 30 states supported Mrs. Clinton, but Mr. Trump led by 49-46 percent among Medicaid beneficiaries in the nine red expansion states that have voted Republican in the last two presidential elections.

Republican senators from those states are among those most skeptical of the repeal bill, and many of the same states have large rural populations that stand to lose the most under the plan’s tax credits.

It’s important to note that while many of Mr. Trump’s supporters might be eligible for a smaller tax credit under the Republican plan, only a fraction of those voters would be immediately affected. According to the C.C.E.S., about 4 percent of Mr. Trump’s supporters purchased a plan on exchanges last year.

The estimates include all people with the potential to be eligible for the subsidy and don’t receive Medicare or Medicaid, not just those who purchased health care on the individual market and already receive a subsidy under the Affordable Care Act.

The data on the slice of voters who currently have insurance purchased on an exchange is thinner. Over all, people who bought their health insurance on exchanges supported Mrs. Clinton by a margin of 55 percent to 39 percent, according to the C.C.E.S. But among the small sample of respondents who would lose more than $5,000 under the Republican plan, more were Trump supporters.

Philip Bump at the Washington Post has a similar analysis, President Trump’s health-care plan probably would make health care pricier for core Trump voters:

President Trump offered his unqualified support for the Obamacare alternative that House Republicans announced Tuesday. “I’m proud to support the replacement plan released by the House of Representatives,” he told GOP lawmakers a few hours after he tweeted about “our wonderful new Healthcare Bill.” At his daily news briefing, White House press secretary Sean Spicer specifically said that the proposal was “the Obamacare replacement plan that everyone has been asking for, the plan that the president ran on.”

If this is the plan that Trump ran on, his voters might be surprised to hear it. Preliminary analysis suggests that Trump’s base of support is more likely to see insurance premium costs rise — often substantially — under Trump’s bill.

When we talk about the core of Trump’s support, we’re talking largely about white working-class voters. Nearly 9 in 10 Trump voters were white, and his support was larger among those who had lower incomes and were older.

Among white voters younger than 30, Trump won by four percentage points nationally, according to exit polling. Among those ages 45 to 64, he won by 28. Income worked in the reverse direction. Those making $250,000 or more a year backed Trump by five points. Those making $50,000 to $99,999 annually supported him by 28.

Shortly after the policy was announced, AARP sent a letter to congressional leaders offering the organization’s unqualified opposition to the policy as written.

“Affordability of both premiums and cost-sharing is critical to older Americans and their ability to obtain and access health care,” the letter reads. “A typical senior seeking coverage through an exchange has a median annual income of under $25,000 and already pays significant out-of-pocket costs for health care.” They offered estimates of how the Obamacare replacement bill might affect older Americans. (Note that the figures below relate to those seeking insurance on an exchange — that is, not through an employer.)

“We estimate that the bill’s changes to current law’s tax credits” — the subsidies provided by the government to reduce the cost of insurance — “could increase premium costs for a 55-year old earning $25,000 by more than $2,300 a year. For a 64-year old earning $25,000 that increase rises to more than $4,400 a year, and more than $5,800 for a 64-year old earning $15,000,” it says. That’s an increase of 9 percent of the 55-year-old’s annual income and 39 percent of the annual income of that 64-year-old earning 15,000 a year. When the analysts combined changes to the tax credits with a proposal to expand ratio of costs relative to younger recipients from 3 to 1 to 5 to 1, the figures were worse. In that case, “taken together, premiums for older adults could increase by as much as $3,600 for a 55-year old earning $25,000 a year, $7,000 for a 64-year old earning $25,000 a year and up to $8,400 for a 64-year old earning $15,000 a year.”

The Kaiser Family Foundation, which has been tracking the effects of the Affordable Care Act (Obamacare) since its inception, put together an interactive tool showing how tax credits might change. If you’re a 40-year-old making $75,000 a year, you’re going to get a 75 percent or higher increase to your tax credits — a beneficial situation for you.

If, however, you’re a 60-year-old making $30,000 a year, you’re going to see a reduction in those tax credits (unless you live in Upstate New York or Massachusetts or parts of central Texas).

Notice that Michigan, Pennsylvania and Wisconsin — states central to Trump’s electoral victory — are all blue on that map, showing that their credits will decrease [Also note how Arizona’s rural counties stand out in stark relief on this map]. The map is by county, so the effects of population are harder to spot, but the general trend is clear. “Generally,” the Foundation writes, “people who are older, lower-income, or live in high-premium areas (like Alaska and Arizona) receive larger tax credits under the ACA than they would under the American Health Care Act replacement.”

The very voters more likely to have supported Trump are also more likely to see their health care costs increase. Remember who lied to you and screwed you.

At some point,Trump may want to set aside his desire to have a quick win on a “repeal” of Obamacare in favor of a policy that’s less likely to distribute the pain of the shift to his core base of support. The hallmark of Trump’s base has been its loyalty, with Trump once bragging that he could shoot someone dead in the middle of Fifth Avenue and his supporters would stick by him. Possibly. But they may be less forgiving if Trump signs a bill into law that negatively affects their own personal health, middle of the street or not.

Jeff Guo of the Post looks at Grant County, Nebraska to explain The GOP’s Obamacare replacement is a disaster for some of its most loyal voters:

This is one of the ironies that lurks the Republicans’ plan to replace Obamacare. Donald Trump’s election foregrounded the growing divide between rural and urban America. But under the current proposal, it is some of the GOP’s most loyal constituents — older, small-town folk — who would lose the most in subsidies.

Aaron Blake of the Post correctly sums up with this headline, The GOP’s Obamacare replacement is looking like a bunch of broken Trump promises:

Two big stories on the Republicans’ Obamacare replacement bill broke late Thursday. And both point to major broken promises for President Trump.

The Washington Post’s Katie Zezima and Christopher Ingraham report that the bill would cut a mental-health and addiction treatment mandate covering 1.3 million Americans — counter to a Trump promise to expand treatment:

The Republican proposal to replace the Affordable Care Act would strip away what advocates say is essential coverage for drug addiction treatment as the number of people dying from opiate overdoses is skyrocketing nationwide.

Beginning in 2020, the plan would eliminate an Affordable Care Act requirement that Medicaid cover basic mental-health and addiction services in states that expanded it, allowing them to decide whether to include those benefits in Medicaid plans.

CNN, meanwhile, is reporting that the Trump White House is negotiating to possibly roll back the Medicaid expansion earlier to appeal to conservatives — counter to Trump’s promise to leave Medicaid alone:

White House officials are beginning to urge House GOP leadership to include an earlier sunset of the Medicaid expansion funds authorized under Obamacare than the 2020 date set by the current bill. The change comes just days after the bill was unveiled and follows a blitz of activism aimed squarely at the White House and President Donald Trump, who has met with conservative leaders in recent days.

Here’s what Trump said last year: “I’m not going to cut Social Security like every other Republican, and I’m not going to cut Medicare or Medicaid.”

On opioids, Trump said in his speech to Congress last week, “Our terrible drug epidemic will slow down and ultimately stop,” adding that he would “expand treatment for those who have become so badly addicted.” During a speech in October, Trump said he would “dramatically expand access to treatment slots and end Medicaid policies that obstruct inpatient treatment.”

[A]s Zezima and Ingraham report, addiction specialists say it’s a very poorly timed rollback.

“Taken as a whole, it is a major retreat from the effort to save lives in the opiate epidemic,” Joshua Sharfstein, the associate dean at Johns Hopkins Medical School, told them.

And cutting the requirement would at the very least seem to run counter to Trump’s promise to expand access to coverage.

* * *

The Medicaid rollback is perhaps a more clear-cut case of a promise going by the wayside. Trump’s promises on entitlements were often unmistakable, saying they wouldn’t be touched. That played into Trump’s populist rhetoric — and was undoubtedly something that entitlement-cut-averse voters liked. But now that the work of actually changing health care is afoot, Trump is working with a party and a House speaker in Paul Ryan with dreams of real entitlement changes (and cuts) to balance the budget and keep the programs sustainable. The GOP as a whole was also skeptical of the Medicaid expansion in the first place, and many GOP governors turned it down.

And these aren’t the only Trump promises that risk being broken by the health-care bill. There is, of course, the massive overall promise that Trump made to attain universal health-care coverage — “insurance for everybody”. The Congressional Budget Office scores aren’t in, but the law’s replacement of Obamacare’s individual coverage mandate seems very likely to reduce the number of Americans who are covered. That’s because it only penalizes people for attaining coverage after not having it for a long period of time; it doesn’t tax them for avoiding coverage altogether if they never actually sign up.

Trump made so many huge promises on the campaign trail — at least 282 of them, according to The Post‘s Jenna Johnson — that keeping every last one of them was always going to be impossible. And every president winds up breaking some promises, as President Barack Obama did.

But Trump promised more than his predecessors — including on some things that were obviously going to be very difficult to deliver on. And now the hard work of actually legislating is proving particularly harsh on some of Trump’s biggest campaign-trail promises.

And we’re only on the first major piece of legislation.

Contact your member of Congress and your senators to oppose this awesomely bad bill.