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Trump voters to lose the most from GOP plan

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Noam N. Levey, Tribune National Bureau

WASHINGTON (TNS) -- Americans who swept President Donald Trump to victory -- lower-income, older voters in conservative, rural parts of the country -- stand to lose the most in federal health care aid under a Republican plan to repeal and replace the Affordable Care Act, according to a Los Angeles Times analysis of county voting and tax credit data.

Among those hit the hardest under the House bill are 60-year-olds with annual incomes of $30,000. In nearly 1,500 counties nationwide, such a person stands to lose more than $6,000 a year in federal insurance subsidies. Ninety percent of those counties backed Trump, the analysis shows.

And 68 of the 70 counties where these consumers would suffer the largest losses supported Trump in November.

Most affected by the Republican health care plan would be parts of Alaska, Arizona, Nebraska, Tennessee and Oklahoma, where insurance subsidies have been crucial in making high-price insurance affordable. All five states went for Trump. Also hit hard would be parts of swing states that backed Trump, including Pennsylvania, North Carolina and Michigan.

Older, low-income residents of some parts of California, including rural counties in the northern part of the state, could also see substantial losses, the data show.

Meanwhile, higher-income, younger Americans -- many of whom live in urban areas won by Democrat Hillary Clinton -- stand to get more assistance in the Republican legislation.

Faring best would be the nation's wealthiest residents, who would get a substantial tax cut with the elimination under the House bill of two levies on high-income taxpayers. Those taxes -- on individuals making more than $200,000 and couples making more than $250,000 -- were included in the Affordable Care Act to help offset the cost of assisting lower-income Americans.

The disproportionate effect of the House Republican plan threatens to undercut one of Trump's core promises that he would take care of all Americans even if Barack Obama's health care law is repealed.

It could also become a serious political liability for Republican lawmakers, some of whom can ill afford to alienate the party's electoral base at a time when Trump remains deeply unpopular.

Only a small share of the electorate receives Affordable Care Act subsidies, but the loss of the aid could deprive tens of millions of a critical lifeline.

The Times analysis is based on county election results compiled by the Associated Press and a report by the nonprofit Kaiser Family Foundation of the projected value of insurance subsidies in 2020 under current law and under House Republicans' proposed alternative.

The House Republican plan is already facing fierce criticism from many patient advocates, including AARP, whose membership includes not only seniors on Medicare but also many Americans between 50 and 65.

"Older Americans need affordable health care services and prescriptions," said AARP Executive Vice President Nancy LeaMond. "We are very concerned that this plan goes in the opposite direction, increasing insurance premiums for older Americans and not doing anything to lower drug costs."

The potential effect of the House legislation is making many Republican lawmakers uncomfortable, including senators from states such as Ohio, West Virginia, Alaska and Arkansas, which have large numbers of low-income white voters who have benefited from the Affordable Care Act.

For years, Trump and other Republicans have relentlessly attacked the health care law for saddling some people with unaffordable health care.

But many of the areas where Trump won big have been helped most by the law's subsidies, which were designed to assist Americans who earn too much to qualify for government Medicaid but can't afford to buy health insurance on their own.

The assistance helps consumers making up to four times the federal poverty level -- or about $48,000 a year. About 8 million Americans who buy coverage on insurance marketplaces such as HealthCare.gov currently receive subsidies.

Larger subsidies are available for people making less money and for people living in regions of the country where health insurance is most expensive.

In Alaska, which has the nation's highest insurance costs, a 60-year-old resident with a $30,000 income qualified this year for $21,048 in federal aid to get health insurance, according to HealthCare.gov.

That kind of assistance makes a huge difference. For example, a health plan from insurer Premera Blue Cross Blue Shield that would normally cost a 60-year-old shopper in Anchorage $1,867 a month costs just $113 after federal subsidies.

Older, lower-income people can get similar savings in many rural parts of the country, largely because health insurance tends to be much more expensive in these regions as there is less competition among medical providers and insurers.

"It is kind of the reverse of what people might think," said Cynthia Cox, an analyst with Kaiser who worked on the tax credit data.

Subsidies in urban areas have tended to be lower.

In Boston, for example, the same 60-year-old with a $30,000 annual income qualifies this year for just a $2,520 annual federal subsidy to buy health coverage, according to Massachusetts Health Connector, that state's marketplace.

The House Republican plan would upend this system. There would be no extra aid for low-income consumers or for residents of regions with high insurance costs.

Instead, the House plan offers a flat subsidy to people based on how old they are. Americans who are younger than 30 would get $2,000. That subsidy would increase up to $4,000 for people who are 60 or older.

This new system would result in huge losses for lower-income, older residents of many rural regions, Kaiser's analysis shows.

In 27 Nebraska counties -- all of which backed Trump -- a 60-year-old shopper with a $30,000 income would see financial aid drop by $12,950 a year under the House Republican legislation.

The annual subsidy in 22 counties in Oklahoma, another Republican stronghold, would fall $11,970. Trump won all but one of the counties by more than 28 percentage points.

Trump and other Republicans say that these voters will nevertheless reap the benefits of the GOP alternative.