Wisconsin counties won by Trump are tied to Obamacare
MADISON, Wis. -- In winning what Republicans see as a mandate to repeal Obamacare, Donald Trump carried the Wisconsin counties that participate in a key part of the health program at higher rates.
MADISON, Wis. - In winning what Republicans see as a mandate to repeal Obamacare, Donald Trump carried the Wisconsin counties that participate in a key part of the health program at higher rates.
An analysis by the Milwaukee Journal Sentinel shows that people living in the 59 counties won by Trump enroll in the Affordable Care Act’s private health insurance exchange at a higher rate than the 13 mostly urban counties that backed Hillary Clinton.
In rural areas like Vilas County, which Trump carried by more than 26 percentage points, residents over the past year enrolled in the subsidized private exchanges at nearly 2 1/2 times the rate of Wisconsin as a whole. In Taylor County, where the president-elect won almost 3 to 1, consumers also are signing up for coverage in the Obamacare exchanges at rates much higher than average.
This political paradox highlights how tricky it will be for Republicans to repeal and replace President Barack Obama’s signature policy, which provides coverage through the exchanges for 224,000 Wisconsin residents and 12.7 million Americans and covers millions more nationwide in public Medicaid programs. Republicans at the federal and state level acknowledge they don’t yet know what the replacement will look like for the Affordable Care Act.
“What do we do with catastrophic care?” said state Sen. Tom Tiffany, a small business owner and Republican from Hazelhurst who represents Vilas County. “That is the key question.”
Republicans have promised to quickly act on Obamacare, though they could also sunset or gradually phase it out to give patients and politicians both more time to work out the changes.
Since the passage of the health law in March 2010, GOP candidates have been campaigning on its repeal and can suddenly make that a reality. But that’s in no small part because of Trump’s success in lower-income rural areas and among voters without a college degree - populations that have some of the greatest difficulty obtaining health insurance through the traditional model of employer-sponsored coverage.
Trump’s voters aren’t necessarily the same people who enroll in the private Obamacare exchanges, but they live in the parts of the Wisconsin with the highest usage rates.
Consider the most recent data:
-On average, 4.1 percent of Wisconsin residents enrolled over the past year in the Obamacare exchanges, which provide a regulated marketplace in which consumers can buy coverage, often at a price subsidized by taxpayers.
-But in the Trump counties, about 4.3 percent of the population is enrolled in the exchanges and in northern Wisconsin counties like Vilas, Iron and Door, the rates of exchange enrollment rise to nearly 10 percent. In all, 157,751 people in the Trump counties enrolled in the exchanges in the most recent year.
-In the counties won by Clinton, 3.8 percent of the population enrolled in the exchanges, or 81,280 in all. The two powerhouse counties for Democrats - Milwaukee and Dane - enrolled at below average rates of 4 percent and 3.2 percent, respectively, and few other Democratic counties have high usage rates.
In addition to these exchanges, there’s another side to Obamacare - an expansion of state Medicaid programs that are used aggressively in urban areas like Milwaukee. But in Wisconsin, Gov. Scott Walker and GOP lawmakers declined to fully expand Medicaid using the money available under the federal law.
U.S. Rep.-elect Mike Gallagher, R-Wis., who will represent some of the rural counties that rely more on the exchanges, said he wants to repeal Obamacare but also offer consumers more choices.
“I don’t want anyone to lose coverage,” Gallagher said. “We need to ensure that people remain covered but also have more options.”
Tiffany, the state senator, said the government could help rural areas by lowering regulations and providing incentives for small clinics looking to deliver low-cost preventative care.
But Sachin Cheda, a Democratic strategist in Milwaukee, said there could be effects to repealing key parts of Obamacare, both for the state’s politics and for the lives of ordinary residents.
“There’s going to be a real consequence to families and that’s going to be the hangover,” he said of the election.
Trump told The Wall Street Journal on Friday he wanted to preserve some popular parts of Obamacare, including the prohibition against insurers denying people coverage because of their health conditions and the provision allowing parents to keep young adult children on their health plans.
But health experts see problems with that: The denial prohibition cuts into insurers’ profits. To ensure these companies could still operate, Obamacare includes an unpopular provision: a mandate that all consumers, including the young and healthy, buy coverage, which helps expand the pool and provide revenue to cover the expenses of those who are sick.
“That’s what a lot of people don’t get is how intertwined that is,” said Jon Peacock, research director of the Wisconsin Council on Children and Families.
Donna Friedsam agreed. Friedsam, a policy director at the University of Wisconsin Population Health Institute, said that prohibiting coverage denials while dropping the coverage mandate could “collapse the individual insurance market” in the United States.