WASHINGTON — Americans in states that Donald Trump carried in his march to the White House account for more than 4 in 5 of those signed up for coverage under the health care law the president still wants to take down.

An Associated Press analysis of new figures from the government found that 7.3 million of the 8.8 million consumers signed up so far for next year come from states Trump won in the 2016 presidential election. The four states with the highest number of sign-ups – Florida, Texas, North Carolina and Georgia, accounting for nearly 3.9 million customers – were all Trump states.

“There’s politics, and then there’s taking care of yourself and your family,” said analyst Chris Sloan of the consulting firm Avalere Health. “You can have political views about a program like the Affordable Care Act, but when you get an opportunity to get subsidized health insurance for you and your family … politics is a distant consideration.”

AP’s analysis found that 11 states beat 2017’s enrollment figures. Of them, eight –Iowa, Kansas, Kentucky, Missouri, Nebraska, North Dakota, South Dakota and Wyoming– went for Trump, who posted double-digit victories in all but Iowa.

To be sure, Trump states are also home to many people who voted for Democrat Hillary Clinton. But the AP’s analysis points to a pattern of benefits from the health law in states the president won. The premium dollars have economic ripple effects, reimbursing hospitals and doctors for services that might otherwise have gone unpaid and written off as bad debt. Also, people with health insurance are better able to manage chronic medical problems, remaining productive, tax-paying members of society.

Such economic and political realities will be in the background when Congress returns in January to another installment of the nation’s long-running debate over health care. Republicans and Democrats seem to have battled to a draw for now.

The year 2019 – the effective date for repeal of the ACA’s requirement that most people have coverage – is looking like a time of reckoning for the law’s insurance markets, which offer subsidized private plans to people who don’t have job-based coverage.

Unexpectedly strong enrollment numbers announced this week for the 39 states served by the federal HealthCare.gov website testify to consumer demand for the program and its guarantee that people with medical problems can’t be turned away. Yet those numbers still lag behind last season’s sign-up total. It’s unclear what the final count for next year will be. Some states running their own insurance websites will continue enrolling people through January.


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