Recently I found an article about states with the highest number of citizens with preexisting conditions.   It was based on statistics from the Kaiser Family Foundation, a well-respected research group.  Since one of the most popular provisions of the Affordable Care Act (Obamacare) requires insurers to cover those with existing health problems, I wondered which states should get the greatest benefit from this law?

I was not surprised to find that 14 of the 15 states with the highest percentage of preexisting health conditions are controlled by Republicans.  West Virginia has the highest percentage at 36; Kentucky is tied for third highest with Alabama at 33 percent.  All three of these states voted heavily for Donald Trump who campaigned on a promise to repeal Obamacare.

Why wasn’t I surprised?  Well, of the top 10 states that are the most dependent on federal government money nine out of 10 are Republican controlled.   These are the states with the lowest median family incomes, the worst economies and the highest percentage of food stamp beneficiaries. To top it off, a recent 24/7 Wall Street article found that Republicans control 12 of the 15 states with the highest percentage of residents receiving disability assistance.  Kentucky had the fourth highest with over 223,000 residents receiving benefits.

Perhaps that was one reason former Kentucky Democratic Gov. Steve Beshear expanded Medicaid coverage and set up Kynect, the state Obamacare exchange. His efforts helped Kentucky achieve one of the largest drops in the uninsured rate of any state.   This result had to create thousands of health care jobs, bring down health insurance costs for all Kentucky policy holders and provide needed support for cash-strapped hospitals and health care providers.

But Beshear’s accomplishments didn’t matter to the voters.  In 2014 Kentuckians elected Tea Party Republican Matt Bevin as governor.  He vowed to cancel the Medicaid expansion and announced plans to dismantle Kynect.  I find it difficult to understand this type of masochism that causes people to vote for Republican politicians who run on platforms that promise to hurt them.  Whatever the reason, it can’t their economic self-interest.

The GOP began to take control of more state governments after the 2010 election, the same year Republicans won control of the U.S. House.  Although the Great Recession resulted from eight years of President George W. Bush’s administration somehow Republicans must have convinced their supporters that the recession was President Obama’s fault.  But I think the 2010 vote was also in part a reaction to the election of a black man as president in 2008.

Numerous articles have been written about why the GOP has dominated in the more rural areas of the country and why Donald Trump prevailed over Hillary Clinton last November.  Of course, there is no single factor that caused these phenomena.

Certainly, it was easy for Trump to craft messages that appealed to the voters.  He simply promised to do whatever pleased the crowd he was addressing.  While many of his claims were false or virtually impossible to accomplish, they must have been effective.

Still, the 2016 presidential campaign doesn’t explain Republican dominance in the south and west that began well before Trump was even a candidate.  In fact, President Ronald Reagan may have gotten this trend started with his appeal to religious groups.

Later Republicans decided to make abortion their issue and they included God, country and Christian values in their messaging.  They also curried favor with the National Rifle Association by strongly opposing gun control.  These issues are always popular with evangelicals and residents of states with large populations of hunters.

Residents in the more rural areas of the country are sometimes referred to as “fiercely independent,” particularly regarding federal government programs that they fear will control their lives.  Republicans capitalized on these concerns by claiming that Obamacare was a government takeover of the health care system.  They hammered on this theme for seven years.

Democrats tend to focus on diversity and inclusiveness, which they believe are fundamental American values.  This causes some voters to think Democrats favor minorities.  And it is a fact that white people are losing their majority status in the U.S. This statistic is very troubling to many of them.  Republicans policies and rhetoric have tended to favor the white race and their anti-immigration policies speak loudly to the fears of these folks.

Republican politicians paint Democrats as elitist, pro-abortion, pro-LGBT, pro-immigration, pro-minority, pro-gun control and pro big government.  This messaging draws in a wide variety of one-issue voters all over the country.

Republicans always give the major tax breaks to the rich; they oppose unions that bargain for higher wages; they refuse to raise the minimum wage; and they vowed to repeal Obamacare, a law that lowered the number of uninsured nationwide dramatically.  These are core economic issues for the majority of Americans.  Still around 2,600 counties that are mostly in less affluent rural areas voted to elect Trump, while around 500 counties that are mostly in the more prosperous urban areas voted for Clinton.

I wish I could more fully explain why many Republicans vote against their self-interests.  The reasons are complicated and hard for many of us to understand.  But Democrats will have to figure this out if they are to take back control of state governments and regain the majority in Congress.