Republicans represent more U.S. congressional districts with below-average health-insurance coverage than Democrats, an irony ensnared in a government shutdown triggered by a law designed to expand access to care.
Districts with less coverage are especially common in Texas, where each of the 36 House seats represents an area with a rate lower than the national average, according to U.S. Census Bureau data compiled by Bloomberg. The state, home to Obamacare opponent Republican Senator Ted Cruz, also has the nation’s highest uninsured rate.
In addition to the South, Western states dominate the map of congressional districts with below-average coverage rates. Besides often being under Republican control, those areas also tend to have sizable immigrant populations and poverty.
The mismatch between the policy votes of the districts’ federal representatives and the needs of their constituents may be partly the result of voter registration and turnout patterns.
“The constituents that they respond to are not the ones without health insurance,” said Eric Heberlig, a political scientist at the University of North Carolina in Charlotte. “The constituents that voted for them and show up at their town-hall meetings are more of the higher-income voters who have health-care insurance and are more conservative in their ideology and don’t want additional government programs that they perceive as benefiting the poor.”
District Totals
Among the nation’s 435 congressional districts, 207 have coverage levels below the national insurance average of 85.3 percent for the non-institutionalized civilian population, the census data shows. Of those, 105 are held by Republicans, while Democrats represent 100 and two are vacant. The rankings are based on the Census Bureau’s annual American Community Survey, which includes margins of error for each district.
Republican opposition to the health-care law is in part a reflection of a polarized Washington where the Patient Protection and Affordable Care Act passed in 2010 with only Democratic votes. That atmosphere helped trigger the standoff between President Barack Obama and House Republicans over funding the health-care law that resulted in the Oct. 1 partial government shutdown.
Cruz, who advocated attaching a provision defunding Obamacare to a budget bill last month in a more than 20-hour Senate floor speech, urged his House colleagues on Oct. 11 to keep up the fight.
Cruz Guidance
“Listen, none of us know what’s going to happen on this Obamacare fight right now,” Cruz said in appearance before the Family Research Council’s Values Voter Summit in Washington. “In my view, the House of Representatives needs to keep doing what it’s been doing, which is standing strong.”
Republican leaders aren’t taking Cruz’s advice this time. They are trying to negotiate an agreement to open the government and lift the nation’s $16.7 trillion debt ceiling by Oct. 17, when the U.S. Treasury Department says it will need to borrow more money to pay the nation’s bills.
“The risk to the Republicans is more that it affects the brand and what the Republican Party is about,” Heberlig said, adding that the party is being identified as “not compromising, and willing to harm the economy over their ideological principles.”
An Oct. 3-6 Gallup poll showed the party’s favorability rating has sunk to a record low. Just 28 percent of Americans rate Republicans favorably, the lowest for either party since Gallup started asking the question in 1992. The number is down 10 percentage points from September.
Blaming Republicans
A NBC News/Wall Street Journal poll released Oct. 10 showed 53 percent blame Republicans more for the shutdown, compared with 31 percent faulting Obama. That poll also showed a seven-point increase in those favoring Obamacare since mid-September, with 38 percent of Americans saying they think the law is a good idea, while 43 percent say it isn’t.
The attacks on the health-care law also could further alienate Hispanics from the Republican Party.
The congressional districts with the highest rates of uninsured residents also have large Hispanic populations. The party is trying to boost standing with Hispanics, after 2012 election exit polls showed Obama had a 44-percentage-point advantage among that voting bloc, which is the fastest growing.
Texas State Senator Leticia Van de Putte, a Democrat and pharmacist from San Antonio, said trying to block access to Obamacare is just the latest way Republicans are alienating themselves from a group they need to start winning.
Hispanic Voters
“Republicans need Latino voters and right now they are alienating Latino voters,” she said. “It’s a cumulative affect.”
A wide range of coverage exists across the U.S., with lower-income districts in urban areas held by Democrats also having some of the nation’s highest uninsured rates, the data show. Among the 50 most uninsured districts, Democrats hold 40.
A Dallas-area district represented by Democrat Marc Veasey has the highest rate of uninsured residents among the nation’s congressional districts, with almost four in 10 lacking insurance. Four of the top five congressional districts with the lowest coverage levels are in Texas.
On the opposite end of the spectrum is the suburban Boston district represented by Democrat Joe Kennedy, where virtually everyone has health care. Massachusetts already requires residents to have coverage under a 2006 law signed by last year’s Republican presidential nominee Mitt Romney when he was governor of the state.
Political Price
Veasey, whose district is 66 percent Hispanic and 15 percent black, predicted that Obamacare will become more popular once the initial bugs are worked out, and that Republicans will suffer consequences for trying to block it.
“They believe that in order to get re-elected that they are dependent on the Tea Party,” he said, noting the influence of the limited-government wing of the Republican Party. “They are eventually going to pay the price for it, even in Texas.”
Representative David Valadao, whose majority-Hispanic district in California’s Central Valley has the third-highest rate of uninsured and the fourth-lowest median income of any House district held by a Republican, said his opposition to Obamacare reflects the law’s unpopularity in his district.
“About 4 or 5 percent of the people in my district support Obamacare,” he said, adding that there’s been “surprised reaction about the cost” and “how it’s affected their actual insurance rates.”
Repeal Vote
In May, Valadao voted to repeal the law in its entirety. He voted last month for a stopgap government funding bill that would have delayed many of its central provisions for one year.
He is being challenged for re-election by Democrat Amanda Renterio, a Latino and former aide to Senators Dianne Feinstein of California and Debbie Stabenow of Michigan.
Valadao’s district gave Obama 55 percent of the vote in the 2012 election, the president’s second-best showing in a district that also elected a House Republican. The district also has one of the lowest voter turnout rates in the nation, casting the second-fewest total votes in the 2012 election of all House districts.
The Republican-held district with the highest level of uninsured residents is one in southern Florida represented by Mario Diaz-Balart. Almost one in three people -- 29.1 percent -- don’t have coverage in a district that is 71.8 percent Hispanic.
Government Shutdown
Diaz-Balart, a Miami-area Republican, favors defunding or delaying Obamacare. Even so, he joined 11 other Republicans on a vote that would have kept the government open because he disagreed with his party’s tactics of tying the two issues. He didn’t respond to e-mail and telephone requests for comment.
In Texas, those working at the grassroots level to enroll people in Obamacare say the debate in Washington is creating confusion.
“The situation in Washington is causing messaging that makes it difficult for people to understand the status of Obamacare,” said Ron Cookston, executive director of Gateway to Care, a Houston nonprofit promoting enrollment. “Many people are not clear that in fact ACA is rolling out and enrollment is rolling out.”
Others in Texas say politics are far from the minds of those trying to get insurance.
“On the ground, the people who are uninsured in Texas are very interested in becoming insured,” said Mimi Garcia, state director for Enroll America, another group working to help people get coverage under the law. “For them, it’s not a political decision. It’s just about their family livelihood.”
To contact the reporters on this story: John McCormick in Chicago at jmccormick16@bloomberg.net; Greg Giroux in Washington at ggiroux@bloomberg.net
To contact the editor responsible for this story: Jeanne Cummings at jcummings21@bloomberg.net
U.S. Senator Ted Cruz
Melina Mara/The Washington Post via Getty Images
U.S. Senator Ted Cruz, a Texas Republican, who advocated attaching a provision defunding Obamacare to a budget bill last month in a more than 20-hour Senate floor speech, urged his House colleagues on Oct. 11 to keep up the fight.
U.S. Senator Ted Cruz, a Texas Republican, who advocated attaching a provision defunding Obamacare to a budget bill last month in a more than 20-hour Senate floor speech, urged his House colleagues on Oct. 11 to keep up the fight. Photographer: Melina Mara/The Washington Post via Getty Images
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