THE WISCONSIN VOTER

Rural Wisconsin takes hit in GOP health plan after backing Donald Trump

Craig Gilbert
Milwaukee Journal Sentinel

No congressional district in Wisconsin delivered a bigger victory margin for Donald Trump last fall (20 points) than the rural northern one represented by Republican Sean Duffy.

But by one key measure, no district in Wisconsin would lose more health care aid under the GOP plan to replace Obamacare.

Wisconsin is part of a national pattern in which the Obamacare enrollees who appear to be hit the hardest by the Republican plan fit the demographic and geographic profile of Trump’s political base.

These enrollees are in their 50s and early 60s. Trump won that group by 15 points in Wisconsin, according to exit polling.

And they disproportionately live in rural areas that voted for Trump and are represented by Republicans in Congress.

Take the case of a fairly typical Obamacare enrollee — a 60-year-old with an income of $30,000.

Nationwide, this man or woman would lose an average of $4,150 per year in health care tax credits and subsidies under the GOP plan, according to a study by the Kaiser Family Foundation.

But those cuts would vary dramatically from county to county.

In Wisconsin, the cuts would be much smaller in the southwest and south central parts of the state. In Sauk County, for example, a 60-year-old with an income of $30,000 would lose $1,300 in tax credits and subsidies for his or her health care plan compared to current law.

But in some northern and western counties, that assistance would decrease by more than $7,000.

The main reason?

Under Obamacare, the financial aid people get to help them buy their health insurance is more generous in areas where health care costs are higher. Those areas include many rural counties where there are fewer health care providers.

“They’re getting a larger tax credit under the Affordable Care Act. And they would lose out on that under the House bill,” Cynthia Cox, an analyst with Kaiser, said of those areas.


RELATED: GOP health care plan shifts benefits toward higher-income people
RELATED: How Obamacare became a political football

Under the GOP plan, tax credits would not differ from county to county or region to region. There would be no boost in aid for people in places with high health care costs. That’s why those enrollees would see the biggest decline in their tax credits.

And because those areas are disproportionately rural and Republican, that complicates the politics of getting the GOP plan through Congress, where it may be voted on this week.

Republicans are weighing changes in the bill to secure the votes they need from within their own party for final passage, and those changes could include tweaks to the tax credits. House Speaker Paul Ryan of Janesville indicated on Fox News Sunday that tax credits to older enrollees will likely be increased in the final version of the bill.

In the legislation, the biggest losses in tax credits in Wisconsin would occur in two mostly rural congressional districts, the northern seat held by Duffy and the western seat held by Democrat Ron Kind.

Duffy’s district has the highest number of Obamacare enrollees in the state (more than 35,000 last year) and Kind’s has the third highest.

Both areas were carried by Trump last fall. They are also the two congressional districts in Wisconsin that saw the biggest swings toward the GOP in 2016.

In both districts, a 60-year-old making $30,000 would lose an average of more than $5,500 a year in health care tax credits under the GOP plan, based on a Journal Sentinel analysis of the Kaiser data.

For older, low-income couples, the loss in tax credits would top $15,000 in parts of both districts.

RELATED: Trump counties tied to Obamacare
RELATED: In western Wisconsin, Trump voters want change

“When I saw their plan ... I immediately said, ‘This is not going to be good for rural Wisconsin or rural America generally,’ which is ironic, given where (Trump’s) base of support came from,” said Kind, who voted against the GOP plan when it was approved along party lines by the House Ways and Means Committee.

“Without the means to pay for (plans), they won't be able to get covered,” said Kind.

Duffy said Saturday he has concerns about the ability of some older people to purchase a health care plan with the GOP tax credit as it is currently designed.

“The final page hasn’t been written” on the bill, he said. “Maybe we can improve the amount of money that an individual in their 60s gets in regard to their refundable tax credit.”

But Duffy said he did not favor the approach under Obamacare of offering bigger tax credits to people in higher-cost counties (though that has meant more generous subsidies in his rural district). And that view appears to be the prevailing one among House Republicans.

Duffy said that is the kind of government “micromanaging … we’re trying to get away from.”

More broadly, Duffy argued that Obamacare was unpopular in his district and was making health care more costly. He argued the GOP plan would create more competition, lower costs and, as a result, “my communities will get helped far more than what they have under Obamacare.”

While northern and western Wisconsin would see the biggest losses in tax credits under the GOP plan, parts of southern Wisconsin would be hurt a lot less.

The district that would see by far the smallest cuts in tax credits for older enrollees is one that voted heavily against Trump: the seat anchored by Madison and represented by Democrat Mark Pocan.

In Pocan’s district, the average loss in tax credits for a 60-year-old with a $30,000 income would be less than $2,000 a year — a much smaller reduction than in northern Wisconsin.

And a 40-year-old enrollee in Pocan’s district with the same $30,000 income would actually get more assistance, not less, under the GOP plan, which treats younger and higher-income enrollees more favorably than the current system.

There were roughly 240,000 people enrolled in health plans on the federal marketplace under Obamacare last year in Wisconsin.

The analysis in this story is based on just one measure (premium subsidies and tax credits) of how those Obamacare enrollees would fare under the GOP plan.

For example, it does not take into account the loss of cost-sharing subsidies for lower-income enrollees, the impact of Medicaid changes and cutbacks, or the potential of higher premiums for older enrollees.

A recent analysis by the Congressional Budget Office found that the GOP plan would save more than $300 billion over 10 years but would result in an additional 24 million people being uninsured.