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Why some Americans vote against their own health care interests

Many voters have a hard time believing Republicans would be cartoonishly malevolent, so they end up voting against their own health care interests.
A man holds a sign directing people to an insurance company where they can sign up for the Affordable Care Act, also known as Obamacare in Miami, Fla in 2015. (Photo by Joe Raedle/Getty)
A man holds a sign directing people to an insurance company where they can sign up for the Affordable Care Act, also known as Obamacare in Miami, Fla in 2015.
A couple of weeks ago, we talked about those Americans who like and rely on the Affordable Care Act, but who nevertheless voted for Donald Trump -- who's vowed to scrap the Affordable Care Act. To get a better sense of these voters' motivations, Vox's Sarah Kliff and Byrd Pinkerton traveled last week to Corbin, Kentucky, where "Obamacare" has had great success in lowering the uninsured rate, but where the clear majority of local voters backed Trump.The question was straightforward: "Why would people vote for a presidential candidate who campaigned on taking away their health insurance?" Vox's reports on this are well worth your time, but there was one exchange that stood out for me between Kliff and a local woman named Debbie Mills, a 53-year-old woman whose husband has a serious medical condition. Mills, who cast her ballot for Trump, explained that "it's been great to have health insurance, because I couldn't imagine what it would be like to not have it."

KLIFF: Do you think if [the ACA] does go away, you'll regret your vote in any way? Thinking, "I voted for this person who took away my health insurance." Or ... it's like, that's one of so many things, like you said, jobs, the economy?MILLS: I don't know. I guess I thought that, you know, he would not do this. That they would not do this, would not take the insurance away. Knowing that it's affecting so many people's lives. I mean, what are you to do then if you cannot ... purchase, cannot pay for the insurance? You know, what are we to do?

Mills ended up asking Kliff if the health care law could be changed. After hearing that it can, the woman conceded, "You're scaring me now, on the insurance part. 'Cause I have been in a panic, so I'm afraid now that the insurance is going to go away and we're going to be up a creek."This dovetails with another conversation Vox had with a local voter named Kathy Oller, an ACA enrollment worker who also voted for Trump. Oller argued that Trump "can't" scrap the Affordable Care Act "because everybody has to have health care. You can't go backward."It's terribly sad to read reports like these. We're talking about people and families who have health security, but who nevertheless voted for a candidate who is fully committed to taking that security away. The potential impact on these Americans' lives is genuinely scary.So why did they vote the way they did? Why jeopardize benefits that their families need? I suspect a lot of this has to do with incredulity.Look again at some of those quotes: the first woman assumed that Trump wouldn't follow through on his campaign promise because she simply didn't believe he would "take the insurance away." The second woman may have voted Republican, but she nevertheless believes Trump "can't" repeal the law "because everybody has to have health care."It reminds me of a story long-time readers may recall. In October 2001, shortly after the 9/11 attacks, Republican policymakers pushed for what they called an "economic stimulus" bill. The GOP plan was absurd: the "stimulus" was a massive corporate giveaway, tilted towards the richest of the rich. The Wall Street Journal conceded at the time that the plan "mainly padded corporate bottom lines."Democrats, eager to expose the ridiculous GOP agenda, convened focus groups to sharpen their message, but quickly ran into trouble: voters thought it was impossible that the GOP would actually do this. Paul Krugman explained at the time that the Republican stimulus "was so extreme that when political consultants tried to get reactions from voter focus groups, the voters refused to believe that they were describing the bill accurately."More than a decade later, a pro-Obama super PAC, Priorities USA Action, put together a focus group to test messages against Mitt Romney ahead of the 2012 campaign. When voters were told that Romney supported a budget plan that would privatize Medicare and slash tax rates on the wealthy, the voters "simply refused to believe any politician would do such a thing."As Jon Chait put it, focus group participants were hearing accurate descriptions, but the truth "struck those voters as so cartoonishly evil that they found the charge implausible."These instincts linger. Voters who rely on the ACA may have heard election-season rhetoric about Republicans targeting health care benefits, but many of these some voters concluded that Trump & Co. "can't" repeal the law "because everybody has to have health care."Describing the Republican agenda accurately isn't enough -- because these are voters who perceive facts as an ugly caricature. The truth about Trump's plans strikes many Americans as literally unbelievable.The price for their incredulity is likely to be high.