The part of Maine that backed Trump is least likely to benefit from GOP health plan

March 15--Areas of Maine that backed President Donald Trump in last year's election stand to lose the most federal aid to buy health insurance under the House Republicans' plan to repeal Obamacare, an analysis of Maine voter and tax credit data shows.

In much of Maine's 2nd Congressional District -- which awarded Trump one of the state's four electoral votes in a historic split -- low-income residents would fare worse under the plan. Particularly hard hit would be older Mainers in those northern counties, even those earning middle-class wages.

By contrast, in Maine's generally younger 1st District, which went heavily for Democrat Hillary Clinton, residents at nearly all income levels would receive more assistance from the government under the Republican plan.

Take a 60-year-old in Piscataquis County, for example, which voted for Trump by the largest margin, who earns $30,000 a year. That individual would see federal aid drop nearly 60 percent, from $9,730 under Obamacare to $4,000 under the GOP proposal. Older residents there would have to earn more than $50,000 to see a net benefit from the Republican plan.

Compare that to a 27-year-old in Cumberland County, which went hardest for Clinton, who earns $30,000 a year. That person's tax credit would rise from $1,470 to $2,000, a jump of 36 percent.

On average, tax credits would fall by $2,549, or 46 percent, in Maine, according a report by the liberal Center on Budget and Policy Priorities.

The disparities even out across Maine the more that residents earn, which could make the Republican proposal attractive to a key constituency: Trump voters who aren't poor but still struggle to afford health insurance. They get nothing under Obamacare, but at least some relief from the feds under so-called RyanCare.

Our analysis combined a report from the nonprofit Kaiser Family Foundation, which projected tax credits in 2020 under Obamacare and the Republican alternative, with county-level election data.

Our findings track with similar analyses at the national level that found Trump voters would be among the biggest losers under the Republican plan.

It also lines up with what we know about the demographics of Trump voters, who are largely white, older, and living in areas with fewer immigrants. That describes Maine in general, but especially the more northern areas.

As the impacts of the Republican bill emerge, it's been slow to win enthusiasm even among conservatives.

U.S. Rep. Bruce Poliquin, who serves the 2nd District, previously issued a statement expressing support for popular elements of the Affordable Care Act that are included in the House GOP plan, but he is aggressively not taking a stance on the proposal, based on Tuesday emails from his staff.

U.S. Sen Susan Collins has expressed concern about the bill, while U.S. Sen. Angus King and U.S. Rep. Chellie Pingree oppose it.

Rewarding longevity

Both Obamacare and the new Republican proposal, called the American Health Care Act, provide consumers with tax credits to buy a health plan. The credits help people who buy their own health insurance, rather than get coverage through work or government programs such as Medicaid and Medicare.

But each calculates the assistance amounts differently.

Obamacare, or the Affordable Care Act, bases tax credits primarily on income, with poorer people getting more and wealthier Americans getting a smaller amount. It also takes into account age and the local cost of health insurance. The vast majority of the 77,000 Maine consumers with ACA plans, 85 percent, rely on these tax credits to afford their monthly premiums.

The Republican plan bases tax credits on how old you are, not how much you make. Everyone who makes less than $75,000 a year, or $150,000 for couples filing taxes jointly, would get the same amount of federal assistance according to the following age brackets:

-- $2,000 for people under 30

-- $2,500 for those between 30 and 40

-- $3,000 for those between 40 and 50

-- $3,500 for those between 50 and 60

-- $4,000 for those over 60

People above that income level would see their credits phased out.

Penalizing infirmity

Even though older Americans get the most generous tax credit under the House Republican plan, here's why they fare much better under Obamacare (at least as far as the federal leg up goes) in northern Maine. While age generally rises as you travel from south to north, household income generally drops, so older Mainers are typically poorer as well.

Obamacare's accounting for income benefits them more, on the whole, than Ryancare's accounting for age.

The GOP plan also includes another provision that experts predict will offset any tax credit advantage that older, richer Americans might get.

Older people are generally sicker and therefore cost insurers more money to cover. But the ACA allows insurers to charge older enrollees no more than three times as much as a younger person.

Under the Republican proposal, insurers would be permitted to charge them five times more.

In a relatively old state such as Maine, that could mean much higher premiums for many residents, though lower monthly costs for younger ones.

The nonpartisan Congressional Budget Office estimated this week that insurance premiums would rise 15 percent to 20 percent in both 2018 and 2019 under the Republicans' plan, because fewer healthy people would enroll following the repeal of Obamacare's penalty for skipping insurance. But it expects those increases to be offset after 2020 by $100 billion the bill would award to states and by deregulation of the insurance market.

Sour and sweet spots

It goes without saying that you don't have to be poor to struggle to afford health insurance. Under Obamacare, a fair number of people in that situation get no help from the federal government to pay their premiums. The tax credits dry up entirely if you earn more than 400 percent of the federal poverty level, or about $47,520 for an individual. It doesn't matter how old you are.

(You also get nothing if you earn less than the poverty level, leaving tens of thousands of people with no insurance in states like Maine that didn't expand Medicaid.)

As others have pointed out, if you're someone who earns just a little too much to qualify for an Obamacare subsidy, the Republican plan could prove appealing. You go from getting nothing to at least something, even if you're older and facing higher premiums that will eat up most or all of your tax credit.

Once your income goes north of $50,000 a year, the Ryan plan is universally better as far as the tax credits go. Every Mainer earning between that amount and $100,000 a year would fare better under the Republicans' plan, regardless of age, the Kaiser data show.

That also happens to be the income group that was more likely to vote for Trump, according to national statistics.

BDN Maine reporter Darren Fishell contributed to this analysis and provided data visualizations.

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