Big Risk for Republicans Who Loathe Health Exchanges

Christopher Flavelle writes editorials on health care, energy and environment for Bloomberg View. He was a senior policy analyst for Bloomberg Government and chief speechwriter for the leader of the Liberal Party of Canada.
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Most Republican governors have refused to help implement state insurance exchanges under Obamacare, one more illustration of the enduring political divide over the law. A look at 2012 exit polls suggests that obstruction may not only be bad for the uninsured -- it could be bad for Republicans.

In an editorial today, we argue that even Republican-led states that have opted not to run their own exchanges can still take steps to make those exchanges a success. They not only have the means to help exchanges succeed; Republicans also have a political incentive. That's because many of those who stand to benefit from the exchanges vote Republican.

Federal exchange subsidies are available for people earning between 138 percent and 400 percent of the poverty line, or $32,500 to $94,200 for a family of four based on 2013 federal poverty guidelines. According to 2012 exit polls, 42 percent of people with family incomes between $30,000 and $50,000 voted for Republican presidential candidate Mitt Romney; for those earning between $50,000 and $100,000, the share was 52 percent.

Those figures are even more compelling in some of the most populous Republican-led states. Joe Lenski, executive vice president of Edison Research, which conducted the 2012 exit polls, provided Bloomberg View with responses by income group for four states that have taken a hands-off approach to their exchanges: Florida, North Carolina, Ohio and Pennsylvania.

The polling data raise questions about just how smart it is for those states to leave the success of their exchanges up to the federal government alone.

Start with Florida: 43 percent of those with family incomes between $30,000 and $50,000 reported voting for Romney, as did 54 percent in the $50,000 to $100,000 category. Both figures are slightly above the national averages. Ohio was a similar story, with 43 percent of those in the lower range and 52 percent in the higher one voting Republican.

The pitfalls for Republicans look even starker in North Carolina, where Obama and Romney almost split the $30,000 to $50,000 category, 51 to 49. Romney won the $50,000 to $100,000 group with 54 percent, the same as in Florida. The only income group that went strongly for Obama in North Carolina was made up of people reporting income of less than $30,000, many of whom will be ineligible to qualify for subsidies and will have to get insurance some other way.

Of the four states, the greatest split between the two income groups was in Pennsylvania, where Romney won just 38 percent of the $30,000 to $50,000 category, but 58 percent of those earning $50,000 to $100,000. In fact, that second subset was more likely to vote Republican than any other group in Pennsylvania, even those making more than $250,000. So by turning his back on exchanges, Governor Tom Corbett risks hurting his party's staunchest supporters.

Is any of this enough to cause Republican governors and lawmakers to reconsider their opposition to exchanges? Probably not when speaking to party activists. But as our editorial argues, there are still plenty of ways Republicans can help exchanges behind the scenes. These poll numbers suggest they might want to give it a try.

This column does not necessarily reflect the opinion of Bloomberg View's editorial board or Bloomberg LP, its owners and investors.

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Christopher Flavelle at