Skip to content →

Suicide voters – Why did so many Obamacare recipients support Trump?

During the 2016 presidential election, Donald Trump repeatedly promised to repeal and replace Obamacare. While he was intense about the repeal, he failed to provide an alternative plan, merely promising that he had a “great” idea.

Despite his lack of a concrete plan, many Obamacare recipients voted for Trump.

In Whitey County, Kentucky, Donald Trump received 82 percent of the vote. The county has a median annual per capita income of $16,748.  88 percent of the adult population has only a high school degree. From 2013 (the launch of Obamacare) to 2016, the percentage of people with health insurance in Whitey County rose from 75 percent to 90 percent. This is a typical development, as the number of low-income, less-educated white workers with insurance increased nationwide from 75 percent to 85 percent, a disproportionate benefit. Nonetheless, 66 percent of these people voted for Trump, only 29 percent for Clinton.

After the election, Trump proposed his own health care plan. An analysis by non-partisan health care experts, The Commonwealth Fund, found that Trump’s plan would leave up to 25 million people without insurance, increase the deficit by 500 million, increase out-of-pocket expenses, and raise insurance denial rates – plenty of reasons for Obamacare recipients to be worried.

Nonetheless, Trump’s support from those helped by the Affordable Care Act has remained strong.

This is an interesting development because one would expect the exact opposite. A candidate insisted on repealing Obamacare without a better alternative. While he promised to come up with a replacement on the fly, any voter whose life depended on the Affordable Care Act should have seen a red flag. Electing a president who has no real knowledge of health care or politics is a gamble with your life. What if Trump cuts off your health insurance and replaces it with an improvised solution? Trump’s stance on health care should have provided a strong motivation to vote for Hillary Clinton. We would expect Obamacare recipient to disproportionately support Clinton, but this expectations is clearly wrong – at least in some counties.

Why did counties with so many people relying on government insurance vote for Trump? What could be more important to them then their health? What offset their instinct for self-preservation?

To answer these questions we have to take a closer look at the reasons why Obamacare recipients supported Donald Trump.

Why popular explanations for Trump’s success fail

We are not the first to ask why Obamacare recipients supported Trump. In interviews, reports, and analyses, we usually hear a mix of the same three explanations:

  • People never believed that the Trump administration could repeal Obamacare.
  • People were dissatisfied with the costs of Obamacare. Some recipients reported out-of-pocket expenses of $2,000 per year, and believed that Trump would streamline the program.
  • People hate Obamacare because it is the brainchild of a left wing former community organizer with a funny last name– Obama.

These answers only explain things on the surface. Dig a little deeper, and it just doesn’t add up.

  • There was no reason to believe Trump would never repeal Obamacare. Health care was one of the few issues on which Trump never faltered. He was always 100 percent insistent that he would repeal Obamacare at the earliest opportunity and gave no indication that this was only campaign talk. Betting their lives on the fact that he would never fulfill his promise is a game of political Russian roulette. One that voters could easily have avoided by choosing another candidate.
  • Why repeal & replace? Why not fix it? Nobody, neither Democrats nor other Republican candidates, wanted to leave Obamacare unchanged. They all had plans to reduce the costs of Obamacare, and they all were more concrete and reassuring than Trump’s vague promise. Some wanted more subsidies; others wanted to get more people into Obamacare to drive down costs. These are fundamental issues that a repeal and replace process is unlikely to fix, which is why Trump’s approach provided a worse solution than the alternatives.

The only argument that remains is that Obamacare has the name Obama in it. Everything else is a post-fact justification of a preconceived notion. As I laid out in my book The Theory of Moral Duality, psychological research suggests that most of our moral considerations are simply justifications for our preconceived intuitions. We are unable to explain why we consider something right or wrong, we just do and then subconsciously select the reasoning that seems the most likely to convince others to agree with us.

A general hatred towards Obama and the Democrats alone, can explain why people voted Republican. However, it is insufficient to explain why Obamacare recipients supported Trump over all other Republican candidates. Even in the primaries, Obamacare recipients supported Trump disproportionally. Why?

Other explanations for Trump’s success elevate conditions to reasons. For example, many claim that Hillary Clinton’s lost the election because of her use of a private email server. These explanations fail to explain why the people who voiced such serious concerns about the security of Clinton’s email sever so easily dismissed Trump’s ties to Russia and his sharing of classified information with the Russian ambassador. If these people were concerned about security, they should have been worried about all of these issues. What protects Trump from the same scrutiny as Clinton?

Finally, some explanations question the intelligence and/or the integrity of Trump supporters, which is ridiculous. People using these explanations are trying to take the easy way out by suggesting that those who disagree with them are stupid and/or evil. This is always wrong – a person who wins an election must have the support of many smart, upright people.

Why Obamacare recipients really supported Trump

Since all popular reasons fail, we have to the explain the phenomenon Trump in a new way. This way is the Theory of Moral Duality. It points us to three ideas that combined to create a destructive dynamic. These ideas are:

  • Partisanship,
  • Being an outsider, and
  • Being a business person.

Each of these ideas shows the three typical signs of destructive ideas. Trump was the perfect person to take advantage of the environment which these ideas combined to create. Each idea alone would have been insufficient to win Trump the Presidency, but all three reasons combined explain what happened.

Let’s look at these ideas, the way they build on each other one, and why they created the stage for Trump.

Step 1: The high moral quantity of partisanship helped Trump get noticed

Over the past decades, the idea of partisanship has become charged with a high moral quantity. There is no need to go into too much detail on how this process happened, since most readers are already familiar with it. The important point is that more and more voters considered party affiliation the most important criteria in the voting decision. Party loyalty, on both sides, became synonymous with integrity, goodness, and trustworthiness.

This process generalized an idea that is impossible to generalize. While it is true party affiliation can be a good indication for whether a politician is likely to support ideas shared by individual voters, the American party system with its loosely organized parties prevents this idea from being generalizable. Regardless of who you are, the entire caucus of one party does not better represent your values than the entire caucus of the other.  In both parties, there are well-intentioned, good-hearted people and simple, incompetent egomaniacs. Voting for a well-intentioned person from a party a person has never voted for is almost always a better decision than voting for an incompetent egomaniac simply because they belong to the right party. Nonetheless, people increasingly pride themselves in always voting for the same party, which might provide a sense of identity but is not a good sign for a democracy. It is not wrong to always vote for the same party, but this vote should be the result of conviction, not blind trust.

In short, many voters charged party affiliation with a high moral quantity because they generalized an ungeneralizable idea. Consequently, the idea developed the three typical signs of destructive ideas:

  1. Division into groups. There is a true America and a wrong, distorted, and degenerate America. Both groups are inherently opposed.
  2. Appeal to higher wisdom. Before the true America was under attack, everything was better than it is now. Republicans represent this true America and its golden time. People who want to elect an African American or a woman to the presidency do not. They are the infinitely evil threat that must be fought at any cost.
  3. Binary argument. Any Republican is better than any Democrat.

The high moral quantity of partisanship led many people to resent Obama, Clinton, and Democrats in general. After eight years under a Democrat President, there was a vacuum waiting to be filled by someone who could mirror the resentment felt by many people who had charged their idea of partisanship with a high moral quantity. Trump was this person. He catalyzed this resentment by promising to lock up hated political opponents and by repeating the accusations and conspiracies of radio talk show hosts.

Other Republican candidates stayed away from similar tactics. They believed that repeating conspiracy theories would never win a presidential nomination, let alone the Presidency, which, under different circumstances, would have been true.

Additionally, Trump’s campaign slogan, ‘Make America Great Again’, appealed to the belief that there was a great American past and that liberals had destroyed it. This belief of a golden past is always the result of faulty logic. No country has ever been perfect, and the United States, too, has dealt with problems at many times in its history. Nonetheless, Ronald Reagan had used the same slogan in 1980, which helped transfer the positive connections Republican voters have with Ronald Reagan to Donald Trump, which increased his appeal.

However, even in 2016, resentment and the belief in a glorious past alone would have been insufficient to win the nomination. But it was enough to get Trump some attention. In prior campaign seasons he was laughed at; but this time, he was able to get a baseline of support – enough for the media and voters to listen to what he had to say.

We will get back to the high moral quantity of partisanship later. For now, the important point is that it opened the door for someone as radical as Trump to enter the political stage.

Step 2: The high moral quantity of being a non-establishment person helped Trump position himself as the savior

After Trump’s radical ideas allowed him to survive the first stage of drop outs from the Republican primary, he had to offer a reason why he was a better alternative than the front runners in the polls. At first, Chris Christie, Jeb Bush, Marco Rubio, and others led Trump by considerable margins. All of them wanted to make changes to Obamacare, so why did Obamacare recipients disproportionally support Trump?

Trump’s supporters’ unshakable belief that he could fix health care without a plan or experience was based on his being an outsider. They wanted Obamacare to go away because they hated the person it stood for, so they had to find someone that could accomplish this goal. The Republican establishment had fought against Obamacare for years but failed to create any change. Therefore, none of the candidates from the Republican establishment were a legitimate choice, which opened the door for Trump.

Trump claimed to be an outsider. In previous elections, the focus was on the fact that he was born into a wealthy family, had little in common with voters, and that there were legitimate concerns about his character. In 2016, none of these things seemed to matter because the focus was on Trump’s perception as someone who was not a career politician.

Whether a person is a career politician can tell us a lot about them. Sometimes, people might want someone who has no connection to previous leaders. But it can’t be generalized. Not all outsiders are a better choice for president than all insiders. Whether a person is a career politician is only one of many criteria by which to judge a candidate.

Because many people overvalued the characteristic of Trump being an outsider, the idea developed the three typical signs of destructive ideas:

  1. Division into groups: there are insiders and outsiders. Outsider represent great American values such as honesty, industry, toughness, etc. Outsiders represent degenerate ideas that threaten all things good and honest. This assumption creates the idea’s infinitely evil threat which is typical with destructive ideologies.
  2. Binary argument: every person is either an insider or an outsider. All insiders are alike, and all outsiders are alike. Clinton is the ultimate insider, Trump is the ultimate outsider. Regardless of their other qualities, the simple fact that Trump is considered an outsider means he is a better candidate for President than any insider.
  3. Appeal to higher wisdom: America was once great, but has been ruined by a corrupt elite. Trump represents the true America, Hillary Clinton represents a counterfeit.

For many Americans, there was a perceived establishment that had to be fought. Trump was both the guy to stick it to them and someone who many believed would be a good President.

Step 3: The high moral quantity of being a business person helped Trump win the nomination

So far, we have explained a lot, but some questions remain. If some people believed that the government needed fixing, why did they consider Trump, a man with no political experience, the right man for the job? There were many outsiders. Why was Trump the one they trusted? He lacked political experience, displayed a total lack of knowledge on many issues, and constant scandals threw a questionable light on his character. Nonetheless, his supporters believed that he could pull off impossible projects, for example replacing Obamacare with a ‘great’ new health care system within his first 100 days in office. Where did this belief come from?

This is where another idea with a high moral quantity comes in: the belief that successful business people can do anything.

This is an interesting idea. While it is true that success in business can be a sign of a good work ethic, honesty, and intelligence, not all successful business man are honest, intelligent, and smart. Some are corrupt, ruthless, and dishonest. Business success, too, is only one of many indicators of a person’s qualification for president. On its own, it is no better indication than, for example, whether or not someone is a good kisser.

There are three main reasons why business success says little about a person’s ability as a politician. These are:

  1. Large parts of success depend on luck, opportunity, and the position we were born into. Trump was born into a wealthy, well-connected real estate family, which became a cornerstone of his business success. Those who were born into less fortunate circumstances are not necessarily worse people than Trump, even if they have never owned their own tower.
  2. Business people can bully others into doing what they want, politicians can’t. When Trump negotiated with small contractors, he was in an advantaged position. He could beat up on them, force them to accept deals that benefitted him disproportionally, and use the power of his oversized legal department to scam them out of their money. When the President negotiates with a Senator, he lacks the same monopoly of power that made it easy for Trump to cheat his contractors. Senators are responsible to their contingencies, their careers depend on doing what gets them reelected. Allowing someone to bully them into doing what is bad for their contingency is an almost certain career-killer.
  3. Business people must leave their weakest people behind, societies can’t. Trump’s iconic sentence, ‘You’re fired’, makes great sense in business, where one main instrument of success is eliminating the weakest people from the company. Politicians are unable to fire unwanted parts of their population – they have to solve problems without leaving anyone behind. Governments that try to leave a part of their people behind sooner or later face resistance from this part. Both sides fight each other with growing resentment, and, eventually, the government can only choose between including these people or violently suppressing them.

All of these tactics can aid a person’s business success, if someone measures business by the size of their fortune – and unquestionably Trump does so – but they translate badly to a society and a government. Most of the tools that created Trump’s supposed business success are useless to him as a president. Ethical business practices might place additional limitations on what people can do, but this is not the topic of this analysis.

The reason why Trump’s being a business person became so significant is that when we are faced with complicated decisions, our minds often reduce the issues to a single criteria. When we search for the right partner, for example, we are prone to reduce this complex decision to the most obvious criteria – looks, money, power, or whatever it might be for us. This process helps us to feel better about our ability to make a good decision, and we all have a need to feel safe about the decisions we make, but it often reduces the quality of our decisions.

The same thing happened when Obamacare recipients allowed the fact that Trump was a business person to convince them that he would be able to fix health care. Because some people generalized the idea of being a business person, they charged the idea with a high moral quantity. Consequently, it developed the three typical signs of destructive ideas.

  1. Division into groups. There are business people and non-business people.
  2. Appeal to higher wisdom. Business people make America great, and non-business people try to ride their coat tails. Consequently, business people must possess some form of higher wisdom.
  3. Binary argument. A person is either a business person or a non-business person. Business people are per definition better than non-business people.

Established politicians were not considered business people, but Trump was. Those Obamacare recipients who had charged the idea of being a business person with a high moral quantity therefore considered Trump to be uniquely qualified to solve the problems of health care.

The high moral quantity of being a business person gave Trump the final push to gain the support of Obamacare recipients and win the nomination.

How Trump won – putting it all together

The combination of these three factors created an infinitely evil threat. Nothing could be worse than Clinton becoming president and the Democrats ruining the United States for another four years. While Trump is a confirmed sexist, racist, and xenophobe who is disliked by almost everyone who has worked with him; while Trump has no experience in politics and a questionable business history, these problems seemed acceptable compared to Hillary Clinton, the personification of all three evil threats which we detail in this article, becoming President. The rest of the world did not see this infinitely evil threat and shook their heads in disbelief how anyone could consider Donald Trump a legitimate candidate for any public office, let alone the President of the most powerful nation in the history of the world.

So far, we have explained the three steps that won Trump the Republican nomination. There is still a fourth step left.

Not all Obamacare recipients who voted for Trump in the election voted for him during the primaries. Those who voted for other candidates had to decide whether they would vote for a Democrat who wanted to keep their potentially life-saving health insurance intact or for a Republican who might take their insurance away. The reason they valued party affiliation over life-saving insurance was the high moral quantity of partisanship.

After Trump won the nomination, the high moral quantity of partisanship gained him the support of those Obamacare recipients that had not charged being an outsider and being a business person with a high moral quantity.

All of the three ideas that we previously mentioned connect and build on each other.

Step Reason Effect
1 High moral quantity of partisanship People wanted to get rid of Obama, and longed for an aggressive Republican who could restore the country’s old glory.
2 High moral quantity of the idea of being an outsider Neither Hillary Clinton nor moderate Republican candidates were an option. Trump had the monopoly on being an outsider.
3 High moral quantity of being a business person People trusted Trump to become a good President despite a complete lack of experience, understanding, knowledge, integrity, decency, and integrity.
4 High moral quantity of partisanship After Trump won the Republican nomination, those Republican voters who had opposed him vehemently started to support him because they would rather vote for a Republican who might let them die than for a Democrat who would keep them alive.

The cumulative effects of three individual high-moral-quantity ideas combined to create a mega high –moral-quantity idea – the idea that Trump was the only right person for the Presidency. This idea shows the three typical signs of a destructive idea:

  1. Appeal to higher wisdom. Because Trump is a business person, a non-establishment person, and a Republican, he is the only person who can save America from the infinitely evil threat of another Democrat President.
  2. Division into groups. There are those who support Trump (us) and those who oppose him (them). Both groups are inherent enemies. They would do everything to hurt us, which is why we must fight them. Their viciousness justifies ours.
  3. Binary argument.
    1. There is only us and them. You are either with us or against us.
    2. It is either Trump or the end of the world. If Trump loses the election, America will decay or cease to exist.

Some people subscribed to this idea 100 percent, some only in part. The resulting spectrum directly reflects the spectrum of Trump supporters. The most radical had charged their ideas with the highest moral quantity, those who were ashamed that they voted for Trump with a less intense moral quantity. Nonetheless, both groups’ ideas had a high moral quantity, which led them to consider voting for Trump more important than keeping their health insurance. They would rather play political Russian roulette than vote for someone they considered an infinitely evil threat.

This analysis also explains why no scandal could hurt Trump. Because three high-moral-quantity ideas had combined to form one mega idea, every scandal was seen as fake news, and even the most far-fetched justifications were believed more readily than evidence and fact. Hillary Clinton’s use of a private email server, therefore, was not the reason why she lost the election. It is merely a justification for the preconceived judgement that she is an infinitely evil threat. When Trump shares intelligence with Russia or faces accusations of collaborating with the Russians, the same idea protects him from any scrutiny.

We all filter the wealth of information around us based on our individual concepts. Regardless of which opinions we have we can always interpret some events in way that seems to justify our opinions. To understand voting decisions, there is no use in analyzing the events people name to justify their decisions. We have to understand the ideas that caused them to filter reality through their lenses and led them consider some events more important than others. If we all distort reality, the important question is why we distort in the specific way that we do. Events themselves are meaningless. If Hillary Clinton would have used a perfectly save government-provided server, Trump supporters would have found a different to consider her evil and Trump their savior. The high moral quantity of their idea required these roles to be filled; everything else is a rationalization to justify this idea.

The Theory of Moral Duality helps us understand these connections. It works without having to question the intelligence or the political understanding of Trump supporters. It appeals neither to racism nor sexism nor xenophobia. I have traveled the southern United States extensively, and a majority of the people I met there are not xenophobic, bigoted sexists. These are kind people who honestly try their best to advance their definition of the good. But it seems to me they charged the three ideas that we analyzed in this blog with too high a moral quantity, which led them to support an unqualified leader who proclaimed destructive ideas.

This way of thinking about the problem is important for all those who oppose Trump. They have to avoid charging their own ideas with a high moral quantity and considering all Trump supporters evil. Otherwise, they would only add fuel to the fire of an escalating rift within the American society and the world in general. The solution is not to beat them, the solution is to understand that there is no us and them. Only answers that can fulfill this criteria can solve the problem.

This reasoning can be adapted to any society. Whenever politicians like Trump rise to power, there must be a combination of high-moral-quantity ideas that convinces even those parts of society who would suffer under these politicians to support them. Trump’s disproportional support by Obamacare recipients is just one example of this process. Understand it, and you can adapt to any society, including yours. This is the great advantage of the Theory of Moral Duality.

One final note

This article focuses on Trump and the Republicans. This does not mean that the described processes are exclusive to them. Democrats went through a similar process. The great popularity of Bernie Sanders, who was perceived as a non-establishment, non-business candidate (the negation of the Republican idea), was based on high-moral-quantity ideas, too.

Interestingly, some Sanders supporters said that they would rather vote for Trump than Clinton because they disliked Clinton so intensely. Only the Theory of Moral Duality can explain this reasoning. Sanders supporters saw Clinton as the infinitely evil threat that legitimized all other alternatives, regardless of how destructive they might be.


  1. The reason why voting for Trump was more important to many Obamacare recipients than keeping their health insurance was that they charged the ideas of partisanship, being a non-establishment person, and being a business person with a high moral quantity.
  2. The three individual high-moral-quantity ideas combined to form one mega idea with a high moral quantity – the idea that America was in a deep crisis from which only Trump could save it.
  3. Trump’s success was the coincidental result of unrelated developments. Trump was the perfect person to take advantage of these developments.

If you liked this article, you will probably enjoy my book The Theory of Moral Duality: How to Avoid Destructive Political Ideas, Heal Divided Societies, and Deal More Kindly With One Another. Get it on Amazon now!

Published in Politics