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Obamacare’s biggest political problem: the people it helps don’t vote, but its critics do

This story, from the New York Times's Abby Goodnough, is a perfect encapsulation of Obamacare's biggest political problem:

Carolyn Bouchard, a diabetic with a slowly healing shoulder fracture, hurried to see her doctor after Matt Bevin was elected governor here this month.

Ms. Bouchard, 60, said she was sick of politics and had not bothered voting. But she knew enough about Mr. Bevin, a conservative Republican who rails against the Affordable Care Act, to be nervous about the Medicaid coverage she gained under the law last year.

"I thought, ‘Before my insurance changes, I’d better go in,’ " she said as she waited at Family Health Centers, a community clinic here.

There is something perfect about this anecdote: Bouchard clearly benefits from Obamacare, or at least believes she does, but less than a decade after the federal government passed the program into law, she's decided she's sick of politics and didn't bother to vote. The result is that she may well lose her insurance — which will, presumably, leave her yet more disgusted by American politics, and make her that much less likely to vote.

This is, Goodnough notes, a broad trend, not just an interesting aberration: The low-income Americans who benefit most from Obamacare are also the least likely to vote. For all the GOP's fears that "free stuff" will drive waves of voter turnout, there's precious little evidence that reliance on the safety net actually increases anyone's likelihood of voting — quite the opposite, actually.

In 2014, more than 50 percent of adults making more than $150,000 voted, while fewer than a quarter of those making less than $10,000 turned out.

voting voter turnout by income Sean McElwee/Demos

The above chart is by Demos's Sean McElwee, who goes on to note that the difference in turnout actually matters — poorer, nonvoting Americans are likelier to support things like, well, Obamacare:

support for policies by voters and nonvoters Sean McElwee/Demos

But by definition, nonvoting Americans don't vote, and so their preferences for things like Obamacare don't get heard. And then, in part because they don't vote, the political system doesn't reflect their interests, which in turn leaves them more frustrated and angry with politics and that much less likely to vote.

The greatest trick the devil ever pulled was making the natural response to disappointment with American politics apathy rather than participation.

All that said, Obamacare now has some strengths, too. And one of them is that the law gives a lot of money to states, and that makes repealing it — once it's in effect — harder than critics think. Goodnough reports that though Matt Bevin ran for governor of Kentucky promising to pull the state out of Obamacare's Medicaid expansion, he seems to be backing off this promise now that he won the election:

Early in his campaign, he said he would reverse the Medicaid expansion completely. More recently, including in several interviews since Election Day, he has said he would seek federal permission to tighten eligibility for the program and impose more rules and costs on the so-called expansion population.

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