Red v. Blue: Who'll be screwed the most by the one-two punch of subsidy expiration & PAPI change?

Back in June I ran an analysis to try and break out just how many Americans are likely to lose healthcare coverage in every Congressional District nationally under the recently-passed MAGA Murder Bill, officially known as H.R.1, the One Big Beautiful Bill.

As I showed at the time, while there's around 65% more people enrolled in Medicaid via ACA expansion in House districts held by Democrats (roughly 12.7 million in blue districts vs. 7.7 million in red districts), there's around 34% more ACA exchange enrollees in red districts (around ~13.9 million vs. ~10.4 million in blue districts).

I then went a step further and broke out the House districts into 10 tiers based on what percent of the vote Donald Trump received last year to take a more granular look and found that, shocker, there's no "winners" here; every district is a loser across the ideological spectrum.

Today I'm doing something similar, with one major change: I'm not including Medicaid this time and am instead looking purely at the ~24 million ACA exchange Qualified Health Plan (QHP) enrollees (along with the ~2 million Basic Health Plan (BHP) enrollees in New York, Minnesota & Oregon) to get an idea of who will be hurt the most by the pending expiration of the enhanced tax credits (as well as the changes to the PAPI formula recently put into place by the Trump Administration).

First, here's what the numbers look like overall:

With BHPs included, the discrepancy drops to around 20% more QHP/BHP enrollees living in House districts won by Republicans than those won by Democrats last fall.

Again, however, this doesn't really tell us much since there are plenty of Republicans in blue districts and plenty of Democrats living in red districts.

I therefore then broke out all 436 districts into 10 groups along the partisan spectrum based on Trump's 2024 vote percent, which looks like this:

Here's what this looks like visually. Again while there are definitely significantly more QHP/BHP enrollees in the redder districts, it's not exactly a massively lopsided trend line...the bluest 4 tiers range from 2.0 - 2.6 million enrollees apiece while the reddest 4 tiers range from 2.5 - 3.4 million.

So, once again, there you have it: No matter how you slice it, over 26 million Americans in BOTH red and blue districts & states are going to be screwed in the near future if the enhanced tax credits are allowed to expire & the PAPI change is kept in place, and millions of them will lose healthcare coverage completely.

HAVING SAID THAT: I'll be writing a separate post about this soon, but I want to be absolutely clear about my position here: A one- or two-year extension of the current tax credits should be an absolute non-starter for Congress.

Setting aside the electoral/political fallout of that for the moment, even from a logistical perspective this would mean the entire healthcare industry (insurance companies and healthcare providers as well as enrollees) would be caught in a constant state of anxiety & uncertainty, not being able to plan ahead.

MAKE THE DAMNED TAX CREDIT UPGRADE PERMANENT.