America prides itself in being “The Land of the Free”, celebrating the ability of anyone to prosper in a land of opportunity. Compared to other countries, this is largely true. But, with this attitude comes a dislike of rules and restrictions and a political system that leans to what people describe as the ‘right’. There is a general mistrust of ‘Big Government’ and a tendency to celebrate those who succeed within the law‚or at least the appearance thereof.

As a result, the only two parties that matter are on an unusual political spectrum. The Democrats are considered ‘liberal’ but would be regarded as ‘centre-right’ anywhere else, The Republicans are conservatives, but verging on the extremist by standards elsewhere. While the country developed its apparently limitless frontier, a no-nonsense, ‘de’il-tak-the-hindmost’ attitude was almost essential. But now limits have been reached around 1970, amiable consensus between the two parties has eroded.

By the contested election of 2000, the gloves were off as George W. Bush’s brother Jeb was suspected of swinging the election his way as Governor of Florida, which held the balance. This came on the back of Republicans derailing Clinton’s attempt at health care reform and attempted impeachment in the 1990s. The bitterness was compounded by Bush’s attempt to cut taxes on the rich and scale back Soicial Security for the poor and the eldery and his laissez-faire approach to regulating big banks lay at the root of the financial crash of 2008.

Into the resulting mess stepped Barack Obama, seen as a beacon of hope, ad not just by  Democrats who elected him. While the rich had been getting steadily richer since that 1970 shift (CEO income had soared from 4 to 40 times workers’ pay), the poor were still poor and  middle class affluence had stagnated. Where this hit hardest was in affording the private and expensive health care available. Social Security eased much of the burden for the elderly through Medicare. Health insurance was provided to workers by good employers. But some 16 million Americans had no health cover at all. People were refused treatment in A&Es, or were ejected from hospitals when they could not pay.

Led by Obama, Democrats wanted to introduce universal health care, along European lines. Republicans claimed this was governmental interference in the market. The real reason was that not only the expensive (and therefore lucrative) medical and pharmaceutical sectors but the $1 trillion medical insurance business—all big donors  to Republicans—saw this as a major threat. They were right.

The result was a compromise in the Affordable Care Act (ACA) , signed int law on March 23rd 2010. This provided extended coverage of Medicaid and Medicare to those less well off. Iy was supposed to extend this to those earning 33% more than the income specified but Republicans fought this through the courts and the compromise arrived at was to allow individual states to decide whether the 100% or the 133% level would apply there.

Because this was a federal program, funded by payments (called FICA) levied nationally, the federal government would have to provide the funds,, whichever was chosen. Most observers expected all 50 states to choose the higher threshold as their residents would benefit from federal money at no cost to themselves.

But a funny thing happened. Democrat-controlled states, without exception,  did take up the option. Most Republican controlled states declined the upper threshold—for reasons that defy logic. These states are a roll-call of the poorest in the nation. Even if you support small government, why would you deny your residents the benefit of free money? Other than dogma, no answer has presented itself in the intervening decade. And representatives from these states wee to the fore in 2018 supporting Trump’s failed attempt to repeal the ACA ( now known colloquially as ‘Obamacare’) in 2018. The map below shows the holdouts,

This seems doubly bizarre, because Dixie Democrats used to rule the roost in America’s South. This because Abraham Lincoln, the president who freed the slaves and fought the Civil War to do so, was a Republican. The still-dominant white elite of the South did not forgive that party for the next century. Only Lyndon Johnson’s efforts on civil rights changed their loyalties.