Residents in poor counties that supported Trump could lose Medicaid coverage if he repeals ACA

McDowell County, West Virginia
(Wikipedia map)

McDowell County, West Virginia has high rates of poverty and unemployment, President Trump scored a lopsided victory in 2016 and many previously uninsured residents gained coverage from Medicaid through former President Barack Obama's Patient Protection and Affordable Care Act. If Trump repeals Obamacare, many of those same people who voted for him could stand to lose benefits. This same story could be written about countless counties across the nation.

"Before the law, most West Virginians without children or disabilities could not qualify for Medicaid, no matter how poor they were," Jessica Contrera reports for The Washington Post. "ACA expanded the program to cover more people" like Clyde Graham, a 54 year-old former coal miner who has been out of work for four years. Because of ACA, Clyde’s visit to Tug River Health Association is covered by Medicaid.

As for the other problems in his life, Graham "has put his hopes in Trump, who came to West Virginia saying he would bring back coal and put miners back to work," Contrera writes. "When Trump mentioned repealing Obamacare, Clyde wasn’t sure what that might mean for his Medicaid. But if he had a job that provided health insurance, he reasoned, he wouldn’t need Medicaid anyway, so he voted for Trump, along with 74 percent of McDowell County," which has the nation's short life expectancy.

Tug River Health Association "treats about 8,700 patients, resulting in some 20,000 visits a year to its five clinics," Contrera writes. "In 2016, 12,284 of those visits were from patients on Medicaid, up from 5,674 in 2013, before the ACA took effect here. Without the ACA, many of those patients wouldn’t be able to afford care."

"In other parts of the country, the primary impact of the ACA has been requiring people to have private health insurance, but in poor and sick communities like McDowell County, the law’s dominant effect has been the Medicaid expansion, which has given more people access to the kind of health care that wasn’t widely available or affordable to them before," Contrera writes. "With an insurance card in her pocket, the patient at Tammy’s window can venture into the realms of medical care that are typically out of reach to those without one: blood work, immunizations, specialized doctors, surgery, physical therapy."