Last Tuesday, Life's Losers got their revenge: with the help of Putin and the FBI they saddled America with a vengeful narcissist with a tiny attention span who has surrounded himself with fascists. They sent their message, that the two establishment parties have left them and their families for roadkill. But few will suffer more under Trump than the frustrated Americans who voted for him.
Yesterday, NPR ran a story that couldn't be more to the point, In Depressed Rural Kentucky, Worries Mount Over Medicaid Cutbacks. Kentucky went all in for Trump last Tuesday. It was a rout. He won 1,202,942 votes (62.5%) to Hillary's 628,834. But that doesn't tell the full story. Last week we showed how most Republican senators up for reelection beat Trump's vote totals in their states. Rubio beat Trump 4,822,182 (52.0%) to 4,605,515 (49.1%). Mark Kirk beat Trump in Illinois 2,150,099 (40.2%) to 2,118,179 votes (39.4%). Kelly Ayotte beat him in New Hampshire 353,525 (47.9%) to 345,598 (47.3%). In Utah, Mike Lee beat him 571,781 votes (68.1%) to 397,005 votes (46.6%). in Ohio, Portman out-polled Trump 3,048,467 to 2,771,984– a 276,483 margin! But in Kentucky it was a different story. Rand Paul was reelected convincingly– but didn't do nearly as well as Trump. He got 1,090,151 votes (57.3%). Trump only lost 2 counties– basically Louisville (Jefferson) and Lexington (Fayette). Paul lost 7.
The NPR piece was set in Clay County, in the impoverished southeastern corner of the state. The last time the county voted for a Democrat was in 1860, when they favored Kentuckian John Breckinridge over Abraham Lincoln. Trump beat Hillary 5,861 (86.6%) to 752 (11.1%), Trump's 5th best-performing county. Rand Paul got almost 1,000 fewer votes there– 4,917 (76.6%). They just loved Mr. Trump. It's 94% white and the median household income is $15,271, with about 40% of the population living below the poverty line, one of the poorest counties in America and the poorest county in the country with a white-majority population. It has been named the unhealthiest county in Kentucky– and one of the most obese. According to a NY Times report two years ago, Clay County looking at “the quality and longevity of life in each county of the nation: educational attainment, household income, jobless rate, disability rate, life expectancy and obesity rate… six counties in eastern Kentucky’s coal country (Breathitt, Clay, Jackson, Lee, Leslie and Magoffin) rank among the bottom 10. Clay County, in dead last, might as well be in a different country. The median household income there is barely above the poverty line, at $22,296, and is just over half the nationwide median. Only 7.4 percent of the population has a bachelor’s degree or higher. The unemployment rate is 12.7 percent. The disability rate is nearly as high, at 11.7 percent. (Nationwide, that figure is 1.3 percent.) Life expectancy is six years shorter than average. Perhaps related, nearly half of Clay County is obese.” This was the Trump heartland last Tuesday and here's the percentage of the vote he got in each:
• Breathitt- 69.6%
• Clay- 86.6%
• Jackson- 88.9%
• Lee- 80.7%
• Leslie- 89.4%
• Magoffin- 74.7%
The Times explained that “[i]t’s coal country, but perhaps in name only. In the first quarter of this year, just 54 people were employed in coal mining in Clay County, a precipitous drop from its coal-production peak in 1980. That year, about 2.5 million tons of coal were taken out of the ground in Clay; this year, the county has produced a fraction of that– just over 38,000 tons. Former mines have been reclaimed, and that land has been repurposed in scattershot ways: a golf course, shopping centers, a medium-security federal prison. But nothing has truly come to replace the industry on which Clay County once depended.” The only solution is moving away.
The NPR piece yesterday made a point about how helpful Obamacare and Medicaid expansion have been in this part of Kentucky. 440,000 low income Kentuckians became newly eligible for free health care because of it.
Next year will likely bring more uncertainty when a Trump administration and a GOP-controlled Congress promise to consider Obamacare's repeal, including a potential reduction in the associated Medicaid expansion in 31 states and the District of Columbia that has led to health coverage for an estimated 10 million people.
Kentucky Gov. Matt Bevin, who was elected in 2015, has argued his state can't afford Medicaid in its current form. Obamacare permitted states to use federal funds to broaden Medicaid eligibility to all adults with incomes at or below 138 percent of the federal poverty level, now $11,880 for individuals. Kentucky's enrollment has doubled since late 2013 and today almost a third of its residents are in the program. The Medicaid expansion under Obamacare in Kentucky has led to one of the sharpest drops in any state's uninsured rate, to 7.5 percent in 2015 from 20 percent two years earlier.
Kentucky's achievement owed much to the success of its state-run exchange, Kynect, in promoting new coverage options under the health law. Kynect was launched under Bevin's Democratic predecessor, Steve Beshear, and dismantled by Bevin this year.
Bevin has threatened to roll back the expansion if the Obama administration doesn't allow him to make major changes, such as requiring Kentucky's beneficiaries to pay monthly premiums of $1 to $37.50 and require nondisabled recipients to work or do community service for free dental and vision care.
Budget pressures are set to rise next year in the 31 states and the District of Columbia where Medicaid was expanded as the federal government reduces its share of those costs. States will pick up 5 percent next year and that will rise gradually to 10 percent by 2020. Under the health law, the federal government paid the full cost of the Medicaid expansion population for 2014-2016.
In a state as cash-strapped as Kentucky, the increased expenses ahead for Medicaid will be significant in Bevin's view– $1.2 billion from 2017 to 2021, according to the waiver request he's made to the Obama administration to change how Medicaid works in his state.
Trump's unexpected victory may help Bevin's chances of winning approval. Before the election, many analysts expected federal officials to reject the governor's plan by the end of the year on the grounds that it would roll back gains in expected coverage.
A Trump administration could decide the matter differently, said Emily Beauregard, executive director of Kentucky Voice for Health, an advocacy group that opposes most waiver changes because they could reduce access to care.
“I think it's much more likely that a waiver could be approved under the Trump administration,” she said. “On the other hand, I wonder if the waiver will be a moot point under a Trump administration, assuming that major pieces of the [Affordable Care Act] are repealed.”
…Clay's location places it inside an area familiar to public health specialists as the South's diabetes and stroke belt. It's also in the so-called “Coronary Valley” encompassing the 10-state Ohio/Mississippi valley region.
About 60 percent of Clay County's 21,000 residents are covered by Medicaid, up from about a third before the expansion. The counties uninsured rate for nonelderly adults has fallen from 29 percent to 10 percent.
Still, the increase in insurance coverage hasn't made Clay's people healthier yet. Local health officials here say achieving that will take a decade or more. Instead, they cite progress in smaller steps: more cancer screenings, more visits to mental health professionals and more prescriptions getting filled. Harder lifestyle changes that are still ahead– such as eating better, quitting smoking and regular exercise– will take more than a couple years to happen, said Aaron Yelowitz, associate professor of economics at the University of Kentucky.
Maybe they just thought it would be more convenient to vote for Trump and bring the rest of the country down to their miserably level of pain and suffering. I mean who wants to stop smoking, stop taking drugs, eat healthy food or do daily exercise? Not the 86.6% of the folks in Clay County who voted for Trump– whose policies will probably shorten their life spans, in effect, putting them out of their misery sooner. But don't just blame Kentuckians– there are people like them all over. Only 39.7% of voters in Mississippi went for Clinton last week– and the number was that high primary because of the “blackbelt” counties like Coahoma, Jefferson, Hinds, Noxubee, Claiborne, Washington, Holmes, Tunica, and Humphries where she won with over 70% of the vote. But look at the white counties like Webster, where Trump won 78.6%, Tishomingo , where he took 85.6%, Union, where he took 80.5%, Itawamba (87.0%), Pearl River (82.2%), Lamar (76.5%), Rankin (75.2%), Smith (77.8%), Alcorn (79.9%) and Pontonoc (79.9%). Look at Greene County, Mississippi. Like Clay, it's one of the poorest counties in America, overwhelmingly white, with a per capita income of $11,868 and with about 20% of the population living below the poverty level. 4 people there voted for Jill Stein and 28 voted for Gary Johnson. Trump won, of course– 4,309 votes for him (80.9%) and 956 for Clinton (18.0%). I'm not sure if this video was filmed in Greene County… but it could have been:
Meanwhile, between his apparently crazy, Adderall-fueled critiques of the wildly popular Broadway play Hamilton and the weekly TV show Saturday Night Live, he's actually managed to get the media's and public's attention off the $25 million settlement he was forced to pay to get out from under 3 of his Trump University fraud suits. See? He's not quite as dumb as everyone not from Kentucky and Mississippi thinks he is.
“When fascism comes to America, it will be wrapped in the flag and carrying the cross.” — Sinclair Lewis