(Analysis by Claude AI)
This scatter plot reveals a fascinating and counterintuitive relationship between political preferences and healthcare policy usage across American states. Let me guide you through what you’re seeing and help you understand why this pattern matters so much for American politics and policy.
Understanding the Basic Framework
Think of this chart as a political-policy map of America. The horizontal axis shows how much each state supported Trump in the 2020 election, spanning from about 30% in strongly Democratic states like Vermont and Massachusetts all the way to around 70% in strongly Republican states like Wyoming and Oklahoma. The vertical axis measures what percentage of each state’s population receives ACA Premium Tax Credits – these are federal subsidies that help people afford health insurance through the Affordable Care Act marketplaces.
The Surprising Pattern That Emerges
Here’s where the story gets interesting, and it’s not what most people would expect. Rather than seeing a simple relationship between political preference and policy usage, we discover something much more complex that tells us a great deal about how American federalism actually works.
Starting with the most Democratic states on the far left, you’ll notice they cluster quite low on ACA marketplace usage – typically between 3-6% of their populations. States like Vermont, Massachusetts, California, and Connecticut all fall into this pattern. This might seem puzzling at first since these are the states that most strongly supported the ACA politically.
Now, as we move toward the center of the political spectrum – into competitive states and those with moderate Republican leanings – something remarkable happens. ACA marketplace usage jumps dramatically upward. Florida stands out as the most striking example, with nearly 18% of its population receiving these tax credits despite being politically competitive. But Florida isn’t alone in this pattern. Georgia reaches about 11%, Texas around 10%, North Carolina climbs to 8-9%, and South Carolina hits about 9%.
Finally, as we continue moving rightward into the most Republican states – those with 60-70% Trump support – ACA usage drops back down to very low levels again. Wyoming, Oklahoma, South Dakota, and similar states cluster at the bottom of the chart.
Why This Inverted Pattern Exists
This bell-curve relationship actually makes perfect sense once we understand the underlying policy landscape, and it teaches us important lessons about how federal programs interact with state-level political decisions.
The strongly Democratic states on the left show low marketplace usage for several interconnected reasons. Many of these states expanded Medicaid under the ACA, providing coverage for lower-income residents who might otherwise use marketplace plans. Additionally, these states tend to have stronger economies with more employer-based insurance coverage, and they often implemented the ACA most fully, creating robust state-based exchanges that may have shifted people into different coverage categories.
The peak usage in politically competitive and moderately Republican states reflects a perfect storm of policy needs. Many of these states chose not to expand Medicaid, creating a coverage gap that marketplace plans help fill. They often have large populations working in industries that don’t traditionally provide employer insurance – think Florida’s tourism and service economy, Texas’s diverse economy with many small businesses, or Georgia’s mix of rural and urban workers. These states implemented the ACA but often with less enthusiasm, meaning marketplace plans became crucial safety nets.
The strongly Republican states on the right show low usage again, but for different reasons than the Democratic states. Many actively resisted ACA implementation, some didn’t expand Medicaid, and some may have created administrative barriers that reduced enrollment. Additionally, some of these states have smaller populations and different economic structures that reduce the need for individual market insurance.
The Deeper Political Implications
This pattern reveals one of the most important ironies in American politics: the states whose populations most benefit from ACA marketplace subsidies often include those that were politically skeptical of the program. Meanwhile, the states that most strongly supported the ACA have populations that rely on it less heavily, often because they implemented complementary policies that provided alternative coverage pathways.
This teaches us that political rhetoric and policy reality don’t always align neatly. It also shows how federal programs interact with state policy choices in complex ways that can produce unexpected outcomes. Understanding these patterns helps us think more sophisticatedly about why certain policies succeed or struggle in different political environments.