Polling suggests that such a move would have the biggest impacts on communities that gave Mr. Trump some of his highest levels of support, potentially complicating the politics of a repeal effort.
More than 20 million Americans now depend on the ACA, also known as Obamacare, for health insurance. Data from Gallup indicate that a lot of those people live in counties that favored Mr. Trump.
The Gallup data, analyzed with the county typology from the American Communities Project, show that eight county types have seen increases in health insurance coverage greater than the national average. Six of those types — representing about 77 million people or 33 million votes, a quarter of the total cast — sided with Mr. Trump, some by very large margins.
Some of the county categories listed in the table were particularly important to Mr. Trump. Swaths of largely rural Graying America, Rural Middle America and Working Class Country counties make up large parts of Florida, Michigan, Pennsylvania and Wisconsin, the states that led to Mr. Trump’s victory.
The fact that insurance coverage rates increased in those counties is not a surprise. They are the kinds of places that the ACA targeted when it aimed to expand coverage. The county categories that show big upticks in insurance coverage had been below the national average for coverage rates in 2008, according to Gallup data. Many of them have median incomes below the national average and struggle with higher than average unemployment rates.
Viewed through a political lens, the numbers suggest a challenge for Mr. Trump and the GOP-led Congress. If Mr. Trump keeps his campaign promise to scrap and replace the ACA, communities that gave him some of his biggest margins would likely see the biggest impact. That reality may be behind Mr. Trump’s expressed interest in holding onto at least parts of the law, particularly provisions that bar insurers from denying insurance on the basis of preexisting conditions and which allow people to keep their older children on parents’ plans.