The GOP Debacle and the New Poor

(Photo: AP/Bill Clark/CQ Roll Call)

Speaker of the House Paul Ryan walks away after holding his press conference to announce the canceled vote on the American Health Care Act on March 24, 2017.

Everybody knows there is no fineness or accuracy of suppression,” says the eponymous hero of Saul Bellow’s The Adventures of Augie March. “If you hold down one thing, you hold down the adjoining.”

Well, everybody except today’s Republican Party.

The GOP’s problem is that the world they knew has changed, but their strategy hasn’t. For decades, Republicans have attacked Democratic efforts to expand or merely defend social insurance by depicting such insurance as benefiting presumably shiftless minorities at the expense of white workers who weren’t all that prosperous themselves.

That’s why Ronald Reagan told stories about a Chicago “welfare queen” who lived high on the public dole. That’s why Rush Limbaugh and others who opposed the Affordable Care Act as it moved through Congress in 2010 portrayed it as a program designed for the almost exclusive benefit of minorities.

The Republican attacks had an economic logic behind them: Most white voters who swallowed the GOP’s line did have incomes high enough—if, sometimes, only barely high enough—to keep them from becoming beneficiaries of such programs themselves. So long as that remained the case, attacks that depicted means-tested social insurance programs like Medicaid as designed to help the Racial Other carried a real punch. Speaker Paul Ryan and the supporters of his bill to decimate the ACA might well have assumed that this venerable bias would help ensure their success.

What they didn’t factor in was the downward mobility of the white working class. The economic and social adversities that white workers have experienced in recent decades—the substitution of low-paying service-sector jobs for more remunerative ones in manufacturing, the hollowing out of factory towns and rural communities, the declining rates of family formation and rising rates of midlife death—haven’t made white workers more racially tolerant, as their support for Donald Trump in November’s election clearly demonstrated. But neither has it made them as eager as they once were to disparage or repeal means-tested social insurance, as their response to the Trump-Ryan health-care dismantling made clear as well.

The Quinnipiac Poll on Ryan’s bill that was released just a few days before the legislation’s demise showed that it commanded just 17 percent support, while 56 percent opposed it. A meager plurality of Republicans supported it—just 41 percent—but the most damaging numbers were those of constituencies on whom Republicans have increasingly come to rely. Whites without college degrees opposed Ryan’s bill 48 percent to 22 percent, while voters between 50 and 64 years old opposed it 62 percent to 16 percent.

More telling still, voters were asked whether they supported or opposed cuts to Medicaid, which, the question read, “helps pay for health care for low income Americans.” Just 22 percent said they supported such cuts, while 74 percent opposed them. Among Republicans, 39 percent supported but 54 percent opposed, while among whites without college degrees, 29 percent supported while 66 percent opposed. The ACA’s extension of Medicaid to Americans with incomes higher than its previous threshold coincided with the decline of many white workers’ incomes to levels at which they became eligible—doubtless contributing to the wider acceptance of the program’s necessity and legitimacy.

Even without the intransigence of the House Freedom Caucus, then, the Ryan bill faced two daunting obstacles. First, it would have eliminated coverage to a large number of working-class whites whose support Republicans can’t risk forfeiting. Second, not only have health-care costs continued to rise, but so has the share of new jobs that don’t come with health insurance. A study by economists Lawrence Katz and Alan Krueger found that of the net increase of nine million jobs created between 2005 and 2015, virtually all that increase came among independent contractors, or workers for sub-contractors, or temporary employment agencies, or in the gig economy—in other words, in the vast majority of cases, in jobs that didn’t come with benefits.

The Ryan bill’s backers assumed there was a sufficiently large bloc of voters who believed their own health coverage was secure enough to make it permissible to go after those Americans in need of public support. As they now try to resurrect a version of that bill, they still assume that’s the case. But they’re assuming wrong. In a nation that’s lost its middle-class majority, people of color aren’t the only ones who feel insecure. Stripping away health coverage from the poor and the working class devastates whites as well as blacks, Trump supporters as well as diehard Democrats.

The shrinkage of the middle class, and of jobs that provide insurance, renders all but impossible any “accuracy of suppression” in the efforts to cut back the ACA. Our economy has devolved past the point where most people believe you can hold down the means-tested benefits for one group, or race, of citizens without holding down the adjoining.

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