The prognosis was never promising. All the various Republican health-care proposals circulated since 2010 would remove health-insurance coverage from tens of millions of people, many of them the GOP’s most loyal voters. Look for example at the dilemma facing Kentucky’s Rand Paul.
Four hundred and forty thousand Kentuckians have gained coverage under the ACA; Kentucky’s uninsured rate tumbled from 20 percent in 2013 to 7.5 percent in 2015.
Even more strikingly, it is Kentucky’s Appalachian Southeast that has seen the biggest gains from the ACA. And it so happens that southeastern Kentucky voted more staunchly for Paul’s 2016 reelection than did any other section of the state.
Paul won 76.6 percent of the vote in Clay County, where 15.6 percent of the total population has gained coverage via the ACA’s Medicaid expansion. He won 81.5 percent of the vote in Jackson County, where 15.1 percent owe their Medicaid to the ACA. He won 84 percent in Leslie County, where 18 percent would lose Medicaid if Obamacare were repealed.
Senator Paul resolved his dilemma in a shrewd way: He spoke to ensure that he kept his standing as the purest of the ideologically pure—and acted to ensure that the white poor of southeastern Kentucky retained their Medicaid coverage.
Senator Rand Paul
Today I join senators Lee, Johnson, and Cruz in opposition to the #HealthcareBill. Read here: http://www.paul.senate.gov/news/press/sens-paul-cruz-johnson-and-lee-issue-joint-statement-on-senate-health-bill …pic.twitter.com/FF9ChIBaBA
FollowSenator Rand Paul
The current #healthcarebill does not repeal Obamacare. It does not keep our promises to the American people.
Other Republican senators found their own excuses to arrive at the same result for their own states. It’s generally reckoned that half the people who gained coverage under the Affordable Care Act did so via Medicaid expansion. The Republican ACA alternative would undo that expansion. Unlike the many regulatory changes Republicans had in mind, such a stripping away of an existing benefit is easy to understand—and a natural target for political payback. No surprise then that the senators flinched.