Obamacare most helpful to rural North Carolina

Dr. John Spangler - Contributing columnist

North Carolina counties which voted for Donald Trump are exactly the counties that need Obamacare the most. Since Congress and the Trump administration want to abolish Obamacare, residents of those counties should take note.

From my perspective as a family physician, the Affordable Care Act works. I have a number of patients who finally have health insurance to pay for preventive cancer screening. They can also receive treatment for their diabetes, high blood pressure, high cholesterol — or even their broken toe.

Before Obamacare, it was too expensive for them to have cancer screening done, much less see the doctor regularly to control their chronic medical conditions.

One way to look at the aggregate health of these Trump voters is to examine death and illness rates in counties and see how each 1 percent increase in a county’s vote for President Trump correlates with poor health conditions.

I did just that with my large database of publically available health and demographic factors at the county level in North Carolina. I applied linear regression techniques to county-level data, controlling for each county’s differing demographics, voting patterns and health rates.

Weeding out unrelated county characteristics, this math technique leaves factors at the county level which together explain the largest amount of a county’s vote count for President Trump.

My results show that three or four demographic factors repeatedly appear in these analyses. Trump counties had the following characteristics: a higher percent white population; lower percent female population; smaller total county population; and lower median incomes. These typically were small, rural counties.

More importantly, counties voting for Donald Trump had higher rates of preventable adverse health conditions, such as smoking, obesity, diabetes, cancer, teen pregnancy, and infant mortality.

These conditions also explain a large portion of the number of votes President Trump received in each county. For example, higher total mortality rates explained 81 percent of his vote count in counties voting for him.

Further, Trump-voting counties had a higher proportion of people eligible for Medicaid as well as higher Medicaid expenditures per capita. There were higher rates of diabetes deaths, colon cancer deaths, and deaths from motor vehicle accidents. More infants died per 1,000 live births in these counties.

Preventing these conditions requires visiting the doctor regularly.

I work every day to help patients stop smoking and manage their weight. I make sure they get regular colon cancer screenings and that pregnant teens get quality prenatal care.

Unfortunately, patients can’t afford to see me regularly without health insurance.

How can people in poor, small counties get health insurance?

One way is to expand Medicaid, which the General Assembly and former governor of North Carolina, Pat McCrory, chose not to do. Indeed, Medicaid is being used by these counties at high rates, but they are probably maxed out since this program was not expanded.

The second way is to enroll uninsured residents in Obamacare.

By and large, North Carolina’s Trump counties have poorer health. Repealing Obamacare will hurt the health of North Carolina’s Trump counties the most. Is this what the residents of these counties want?


Dr. John Spangler

Contributing columnist

Dr. John Spangler is a family physician, public health specialist and epidemiologist. He grew up on Greensboro and has conducted many studies in rural North Carolina dating back to the early 1990s.

Dr. John Spangler is a family physician, public health specialist and epidemiologist. He grew up on Greensboro and has conducted many studies in rural North Carolina dating back to the early 1990s.

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