Friday, June 30, 2017

A Tale of Two Countries


The GOP Congress is hell-bent on repealing the Affordable Care Act because of Obama something, something.... The Senate and House schemes to replace the ACA consist of more tax-cuts for the wealthy, drastic cuts to Medicaid, much higher costs for seniors, and not a single thing to improve the health of Americans.

The main ACA complaint by Republican politicians is that for a handful of counties in backwoods America, there are few insurance options on the exchanges. The fact that Cletus and Maud in Dog-Crap, Missouri cannot buy insurance on their county exchange is somehow being used as an excuse to take insurance away from 23 million people. Rather than implement a simple fix, such as a public option for some local exchanges, GOP politicians see this as a golden opportunity to steal desperately-needed care from the poor.

Ironically, many of the same people who elected Trump, and many of the GOP Congress' own constituents, are the Americans who will be hurt the worst by the travesty of Trumpcare. This week, I would like to examine just how bad the healthcare already is in Republican states. Yet, the politicians who claim to represent these people want to make that care so much worse.

Let's divide the country into two groups-the thirty states whose electoral votes went to Trump, and the twenty states (plus DC) whose electoral votes went to Hillary. We will compare the current status of insurance, health, and outcomes of the two groups to see which is in most dire need of government help. The data I reference below was compiled by the well-respected Kaiser Family Foundation and the US Centers for Disease Control.

First of all, the citizens of Trump states currently have substantially less access to healthcare than the rest of America. No big surprise there. The 30 Trump states have an average of 9.8% of their residents uninsured. In drastic contrast, the 20 states that voted for Hillary have only 6.8% uninsured residents. Much of this inexcusable insurance gap is due to some stubborn Republican governors still denying Medicaid expansion to their people.

Let's look at health-affecting lifestyle differences between the Trump and Hillary groups. Clearly, being fat is detrimental to your health. The average Trump state has a 31.3 % obesity rate, while the average Hillary state comes in at a relatively skinny 26.4% obesity rate. Of the 16 states with the highest obesity rates, each and every one went for Trump.

Other than Mike Pence, everyone understands that smoking adversely affects your health. The overall US adult smoking rate is 16.8%. The 30 states that voted for Trump have a much higher average rate of smoking (19.3%) compared to the 20 states that voted for Hillary (15.6%). But that doesn't tell the whole story. Of the 14 highest smoking states, each and every one went for Trump

So lifestyle factors affecting health are much worse in Trump states. Trump states have more obese people and more smokers. This is compounded by the fact that too many people are without insurance coverage in those same states.

Let's look at numbers that reflect the lack of access to medical help. The suicide rate is some indication of lack of access to psychiatric care. America has an overall suicide rate of 13.3 per 100,000 people. The average Trump state has a suicide rate of 16.6, while the average Hillary state's suicide rate is a substantially lower 13.1.

Teen pregnancies are another tragedy that could, in many cases, be avoided with access to proper healthcare. Contraceptives are cheap, and highly effective. The average Trump state had a teen birth rate of 26.3 (per 1000 females 15-19), while the average Hillary state had a 33% lower rate, at 17.6 per 1000. Nine of the top ten highest teen birth states voted for Trump.


One of the best indicators of a population's health is how people actually feel. A self-evaluation questionnaire found that in Trump states, 18% of people said their health was poor or only fair. This contrasts with Hillary states, where a much lower 15% described their health as poor or fair. 


Another good indicator of a population's health is the expected lifespan of a newborn. Again, Trump states are relatively unhealthy, with an average expected lifespan of 77.9 years. Residents of Hillary states can expect to live 79.7 years-almost two years longer than people in Trump states.

The average Trump-voting state has higher obesity, smoking, teen-pregnancies, and suicide rates than US averages. The unfortunate folks in these states have poorer health outcomes and shorter lifespans. The politicians who claim to represent these people are miserably failing them. These states need better and cheaper access to care, not less. They do not need the snake-oil prescription that GOP politicians are selling them. They do not need the disaster that is Trumpcare. 



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