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The heart-breaking health care crisis that is ravaging working-class and rural communities threatens to cut short Donald Trump’s political career and demands a forceful response from opposition Democrats. It will teach big lessons about how to reach working people who are struggling, regardless of colour.
That is clear to me after listening to white working-class voters in Zoom focus groups for the American Federation of Teachers and Voter Participation Center in the first week of August, outside of metropolitan areas in rural Wisconsin, the Mahoning Valley region in Ohio (also known as Steel Valley), northern Maine and suburban Macomb County, Michigan.
The results of these sessions also fit with the results of a phone survey I conducted of working-class voters in the 16 battleground states, after Joe Biden’s selection of Kamala Harris for vice president and the launch of the Democratic National Convention, though before his final-night acceptance speech. In 2016, a white working-class revolt enabled Trump to win men by an unimaginable 48 points and women by 27. But disillusionment was real in the midterms: The Republican House margin dropped 13 points across the white working class. In the new poll, Trump lost a further 6 points with white working-class women, where Biden only trailed Trump by 8 points (52 to 44 percent). While Trump has been throwing a lot of red meat to his base, white working-class men have not been dislodged from their trajectory, as Trump’s margin eroded another 4 points.
Trump’s loss of support in the pandemic
These are mostly low-wage families, many with children raised by a single parent. They are consumed with rising opioid deaths and disabilities and a deadly expensive health care system. That was a big part of why they voted for Donald Trump in 2016: so he could end Obamacare and its costly mandate and deliver affordable health insurance for all. When he failed to do so, many voted against the Republicans in the midterms.
But the pandemic was the perfect storm. I have never seen such a poignant discussion of the health and disability problems facing families and their children, the risks they faced at work and the prospect of even higher health care and prescription drug costs. The final straw was a president who battled not for the ‘forgotten Americans,’ but for himself, the top one percent and the biggest, greediest companies.
That is why most in the Zoom focus groups pulled back from President Trump. Three-quarters of these voters supported Trump in 2016, but less than half planned to vote for him now. Even those who still supported him did not push back when other participants expressed anger with his doing nothing about health care, fostering hatred and racism, dividing the country, siding with the upper classes, and having no plan for Covid-19. This is a life-and-death issue for them, as much as nearly any other group in American society.
The same voters were still very cautious about Joe Biden, who seemed old and not very strong, but most importantly offered the prospect of only minor changes to the health care system and seemed unlikely to challenge the power of the top one percent. Like lots of other working people, they are looking for a leader who will make big changes in health care, fight for working people over big business and unite the country to defeat the current economic and public-health crisis.
The struggle of working-class and rural communities
Working-class anger with the establishment after the financial crisis of 2008 ran deep into the Democratic base of Blacks, Hispanics, unmarried women and millennials, too. Many were not initially enthusiastic about the Affordable Care Act and in election after election failed to rally fully for Democratic candidates until the 2018 midterms, when Democrats ran on ‘health care, health care, health care!’ The pandemic may allow progressives to battle for working people, regardless of colour.
Just throw out the words ‘health care,’ and people relayed a train of horrors: a ‘USD 16,000 deductible,’ employers throwing them off health insurance, ‘ridiculous’ premiums, a USD 400 bill for their asthma medicine paid for out of pocket.
In today’s working-class and rural communities, health care is everything. In introductory remarks, participants in the focus groups went right to the personal health care crises they were facing every day.
‘My wife is disabled,’ said one man from Wisconsin. ‘My daughter has 30 per cent immune system left so she’s bouncing around from doctor to doctor and the wife says don’t bring [the pandemic] home.’ Another Wisconsin man spoke of his terminally ill seven-year-old son. A woman in Maine explained how she nearly bled to death and had a USD 24,000 medical bill ‘on my credit report for who knows how long.’ One woman from Ohio had two kids with autism and another had a grandson with allergies, requiring access to a lifesaving EpiPen. ‘I haven’t been able to get him one for the last three years, I can’t afford it … my insurance won’t cover it,’ the woman said. Prices have skyrocketed for EpiPens and remain stubbornly high.
The disability pandemic
As I was observing the Zoom group, I initially wondered whether the focus group recruiter had used some specialised list to find the participants. But then I checked the census data on disabilities.
Across the country, 12.6 per cent of the population has disabilities, rising to 15.1 per cent in rural areas. Black and Native American populations are more likely to have disabilities than their white counterparts. The rate is over a quarter for those 65 to 74 years old and half of those over 75 years—all groups that are overrepresented in these rural areas. And structural racism has played a powerful role here: 20 per cent of Blacks with disabilities were employed at the beginning of this year, compared to 30 per cent of whites and Hispanics with disabilities.
Then I looked at census data for the congressional districts where these sessions were being held. It was a new window into America in the pandemic. In suburban Macomb County, the disability rate looks like the rural areas, with 14 per cent of both whites and Blacks disabled. In northern Maine, the numbers show one in five with disabilities, slightly more for whites. In Ohio’s Sixth Congressional District, both one in five whites and Blacks are disabled. And seniors in these areas are even more disabled than other rural Americans.
So Covid-19 violently brought together the personal health crises of these people and the failed and corrupted government response, breaking their emotional bond with Trump.
What does Joe Biden want?
Just throw out the words ‘health care,’ and people relayed a train of horrors: a ‘USD 16,000 deductible,’ employers throwing them off health insurance, ‘ridiculous’ premiums, a USD 400 bill for their asthma medicine paid for out of pocket. They spoke of the frustrations of making too much money to be eligible for Medicaid but not enough to stay in the solid middle class. They explained how people avoid treatment because they can’t pay the associated costs. ‘The way we deliver health care is just unbelievable,’ said one woman from Michigan, ‘the amount of waste and how much it costs to let people go bankrupt to pay for medical bills.’
Most of the respondents live on the edge in a virtual ‘minimum wage’ economy, where companies don’t care about their employees and look just to enrich themselves. ‘You’re just a number now,’ said one Ohio woman. They fight for every dime, as they are being overwhelmed by a health care crisis that they recognise Donald Trump has failed to fix. And importantly, for working families outside poverty, the health care reforms passed by the Democrats—the Affordable Care Act and insurance on the health care exchanges—just were not much help.
In emails we asked the participants to send to President Trump, you can feel that the spirit that led them to join the working-class revolt is just broken.
Discussion of the Affordable Care Act did not sound ideological, as they talked about their direct experience with insurance on the exchanges, which in the words of one woman ‘costs a lot of money and doesn’t pay for much of anything.’ The health care system is failing them and they want someone to fix it. And Joe Biden’s rhetoric has not been very reassuring that he would make big changes. ‘He’s been vague on health care,’ one woman from Wisconsin said. ‘I want to know the specifics of what he’ll do to make it better.’
These working-class and rural swing voters voted overwhelmingly for Trump, but their response to him is now profoundly shaped by what has happened in the Covid-19 crisis. They think he failed to take the virus seriously and has just made a mess of it. They think he is failing at the most important issue for them.
What was striking is how the usual Trump deflect-and-blame strategy no longer works with these swing voters. ‘It seems like a lot of the stuff he’s saying could be proven wrong,’ said one man from Wisconsin. ‘He just won’t admit where things are, he’s out of touch with reality,’ said another woman. ‘It’s just embarrassing to have a country with the highest Covid cases, highest Covid deaths,’ said a man in Michigan. ‘We’re supposed to be the leader in the world and we completely fumbled the ball on this.’
Respondents despaired about the lack of a national plan of action, with everyone ‘just left on their own.’ Meanwhile, there was dismay that the president gave more care to his family’s businesses than the rest of the nation. One woman theorised that he didn’t shut down domestic travel ‘because he owns hotels.’ These participants are paying a lot of attention to the position of Trump’s family in the administration and how the bailouts and loans are benefiting his family business, his cronies and the top one percent.
The spirit of the working-class revolt is broken
At the same time, they are on a financial knife’s edge, worried about being one bad break away from being homeless. The focus groups happened after the USD 600 federal unemployment benefit ended and those in the groups who were out of work despaired of getting by without that. Nearly all of them supported Trump in 2016 because he was a businessman who would grow the economy. But now they’re scared about the economic damage. Trump reminding these voters of his great economic successes before the pandemic fell flat. His economic bravado was not reassuring at a terrifying moment. ‘I remember my father watching the news and crying, and I find myself crying sometimes when I watch the news,’ related a woman from Wisconsin. ‘And I think, oh god, I’m turning into my parents. You have no choice. The things you see are gut-wrenching.’
In emails we asked the participants to send to President Trump, you can feel that the spirit that led them to join the working-class revolt is just broken. While some hope he will get back in the right direction, most used their email to express their deep disillusionment. You can feel that they wanted a president who didn’t divide the country and make it a ‘laughingstock’ (two writers used that exact word) internationally. They wanted a president who put the interests of the people, not just big business, first.
‘I supported you in the beginning over Hillary but in the end unfortunately, you show me you’re just not for the people,’ wrote one man from Wisconsin. ‘You lied to the American people about Covid,’ wrote another. ‘You are everything that is wrong with America, you have effectively ruined this country,’ added a woman from Ohio. ‘Congrats, you suck.’
It is critical to listen for what they did not say: ‘What an ass I was to vote for that guy in the last election.’ They did not regret or say they made a mistake. All working Americans have been in financial trouble since the 2008 crash and rising health care problems and disabilities, health care costs and deductibles, empowered insurance and pharmaceutical companies were an explosive brew. It is why many working people voted for Trump in 2016. It is why many working-class Democrats of colour and millennials failed to turn out and defend Obamacare in midterm elections and in 2016. All these voters had reasons for those choices.
Covid-19 has shattered so many lives, but also seemingly insurmountable political barriers. The great majority of working people, regardless of colour, are desperate for a government that stops taking direction from the pharmaceutical companies and brings the boldest feasible changes to our health care system.