The impending Republican drive to repeal the Affordable Care Act is crystallizing the class contradiction long embedded in the health-care debate.
From the start, President Obama’s health-care reform has faced fierce opposition from working-class whites, the same constituency that anchored Donald Trump’s electoral coalition. But blue-collar whites have been among the law’s principal beneficiaries, particularly in the Rustbelt states that tipped the 2016 race to Trump. The critical question now is whether the practical prospect of losing coverage will dislodge the ideological skepticism about the law that is endemic in white working-class communities.
Since Bill Clinton’s presidency, some Democratic strategists have viewed a pledge to provide universal health care as the party’s best opportunity to refute the widespread view among blue-collar whites that Washington cares less about struggling working families than it cares about the poor (which many of those whites equate mostly with minorities). Yet Obamacare did more to reinforce those perceptions than dissolve them.
In polling by the non-partisan Kaiser Family Foundation, as few as one in eight whites without a college degree have said they believe the law has helped their own families. Far more of those working-class whites have said they believe the law benefits the uninsured and the poor. Most blue-collar whites, in other words, have seen Obamacare less as a universal program, like Social Security or Medicare, that provides a benefit they consider earned, and more like food stamps or welfare that transfers their tax dollars to recipients they tend to consider undeserving. Many college-educated whites have also held that view, though by less emphatic margins.