After the Republican Party passed the American Health Care Act 2.0 with zero Democratic votes today, Democrats in the chamber taunted them by chanting "na na na na, hey hey hey goodbye" on the assumption that many of them would get voted out by their constituents. The optics on this little stunt were horrible—do these people only care about the number of seats they hold, and not about the passage of a bill that will obliterate healthcare coverage for tens of millions? But conventional wisdom is that these Democrats are right. Version 1.0 of the AHCA was super unpopular, and, oh yeah, it was opposed by virtually every healthcare-related group:
So surely Republicans will pay at the polls in 2018 and perhaps 2020 as well. Right?
But what if they won't?
The left is assuming that people who lose their insurance will switch and vote Democrat because the loss of healthcare is a traumatic experience that can literally mean bankruptcy or death. But what if that's not the reason people vote anymore?
In the 2016 election, people voted along ethno-religious lines more than ever before. The vast majority of non-whites voted Democrat. The vast majority of Christian whites voted Republican. As these groups have become increasingly equal in number, they have increasingly voted in blocs. Only 8% of African Americans voted for Trump, even though he was running against the second-least popular candidate of all time whose turnout lagged. A record 81% of white evangelicals voted for Trump. American elections are increasingly a census, where everyone votes along identity-based lines rather than ideological ones. And if an election is a census, to switch sides is to betray your tribe. What if white Christians — 54% of the population as recently as 2008 but only 43% today — feel it would be a betrayal to abandon their group, which already considers itself increasingly persecuted? That would make the loss of their insurance, or even their lives, a secondary concern. Moreover, many of those who lose their insurance won't be part of this in-group, but will belong to America's growing ethnic and racial minorities, who are disproportionately poorer than whites and thus dependent on Medicaid in greater numbers. Medicaid will lose $880 billion in the bill the House just passed. Insurance is all about pooling risk. Perhaps white Christians, the historic power group in the United States, do not wish to pool resources with these others, and are even willing to sacrifice their own individual lot to make sure they don't have to. America's segregated cities and increasingly re-segregated schools show just how far American whites have been willing to go to avoid sharing their lives, communities, and resources with other groups.
I want to stress, I am not white-bashing here, I am human-bashing. This isn't about whites or white evangelicals, it's about how people vote in demographically riven, economically stratified societies. Any historic power group in a democracy facing a demographic challenge can be expected to behave this way. And the overwhelming majority of minority voters who vote Democratic shows this works in all directions. This behavior is not retrograde or irrational: it's highly predictable and can happen any time a society that divides itself into roughly equal-sized identity groups goes to the polls.
But let's say you reject my premise that American political parties are turning into ethnonational power platforms. Let's say you think economic factors are more important in voters' minds. That guarantees nothing in 2018. Donald Trump was elected promising to bring back jobs (and after all, that's how half of America gets its health insurance... although the AHCA will do a number on that too). Economically depressed regions of the country rebelled against the establishment and free trade to elect an economic nationalist. Perhaps they believe that only Trump can fix it, as Trump himself believes. Perhaps that's more important to them, and come midterms they're willing to give the President's party the benefit of the doubt. Maybe they believe that establishment technocrats who could fix the healthcare system have rigged it in favor of elites, and they may not trust Democrats to fix it.
And even if you are still convinced that hordes of healthcare-deprived voters will nonetheless rebel against the GOP over the AHCA, consider this: the Senate map in 2018 is terrible for Democrats, and the House is so badly gerrymandered that the Democrats would need an overwhelming landslide victory to win even a small majority there.
Perhaps I'm wrong. But if Republicans still control both chambers of Congress after the 2018 midterms, the above reasons will probably be why.