“Ashtabula’s problems stand out compared with two nearby counties – Erie, Pa., and Chautauqua, N.Y. All three communities, which ring picturesque Lake Erie and are a short drive from each other, have struggled economically in recent decades as industrial jobs withered – conditions that contribute toward rising midlife mortality, research shows. None is a success story when it comes to health. But Ashtabula residents are much more likely to die young, especially from smoking, diabetes-related complications or motor vehicle accidents, than people living in its sister counties in Pennsylvania and New York, states that have adopted more stringent public health measures.
That pattern held true during the coronavirus pandemic, when Ashtabula residents died of covid at far higher rates than people in Chautauqua and Erie.
The differences around Lake Erie reflect a steady national shift in how public health decisions are being made and who’s making them.
State lawmakers gained autonomy over how to spend federal safety net dollars following Republican President Ronald Reagan’s push to empower the states in the 1980s. Those investments began to diverge sharply along red and blue lines, with conservative lawmakers often balking at public health initiatives they said cost too much or overstepped. Today, people in the South and Midwest, regions largely controlled by Republican state legislators, have increasingly higher chances of dying prematurely compared with those in the more Democratic Northeast and West, according to The Post’s analysis of death rates.
The differences in state policies directly correlate to those years lost, said Jennifer Karas Montez, director of the Center for Aging and Policy Studies at Syracuse University and author of several papers that describe the connection between politics and life expectancy.
Ohio sticks out – for all the wrong reasons. Roughly 1 in 5 Ohioans will die before they turn 65, according to Montez’s analysis using the state’s 2019 death rates. The state, whose legislature has been increasingly dominated by Republicans, has plummeted nationally when it comes to life expectancy rates, moving from middle of the pack to the bottom fifth of states during the last 50 years, The Post found. Ohioans have a similar life expectancy to residents of Slovakia and Ecuador, relatively poor countries.
Like other hard-hit Midwestern counties, Ashtabula has seen a rise in what are known as “deaths of despair” – drug overdoses, alcoholism and suicides – prompting federal and state attention in recent years. But here, as well as in most counties across the United States, those types of deaths are far outnumbered by deaths caused by cardiovascular disease, diabetes, smoking-related cancers and other health issues for residents between 35 and 64 years old, The Post found. Between 2015 and 2019, nearly five times as many Ashtabula residents in their prime died of chronic medical conditions as died of overdoses, suicide and all other external causes combined, according to The Post analysis of the Centers for Disease Control and Prevention’s death records.
Public health officials say Ohio could save lives by adopting measures such as a higher tobacco tax or stricter seat-belt rules, initiatives supported by Gov. Mike DeWine, a Republican generally friendly to their cause.”
“Around the world, they find two conditions that make political parties more likely to accept electoral defeats: “when they believe they stand a reasonable chance of winning again in the future” and when they believe “that losing power will not bring catastrophe — that a change of government will not threaten the lives, livelihoods, or most cherished principles.”
In the 21st century, these conditions no longer held among the GOP’s conservative white base. Democrats were no longer a mere political rival, but avatars of a new and scary social order.
“Not only was America no longer overwhelmingly white, but once entrenched racial hierarchies were weakening. Challenges to white Americans’ long-standing social dominance left many of them with feelings of alienation, displacement, and deprivation,” Levitsky and Ziblatt write. “Many of the party’s voters feared losing … their country — or more accurately, their place in it.”
This, they say, is what made the party vulnerable to conquest by someone like Trump. Rather than fight the base in democracy’s name, traditional Republican elites like Sen. Mitch McConnell (R-KY) acted as “semi-loyal democrats”: leaders who say the right things about supporting democracy and the rule of law, but value partisan victory over everything else — including basic, non-partisan democratic principles. This enabled the entire party to become a vehicle for an anti-democratic agenda.
“Openly authoritarian figures — like coup conspirators or armed insurrectionists — are visible for all to see. By themselves, they often lack the public support or legitimacy to destroy a democracy. But when semi-loyalists — tucked away in the hallways of power — lend a hand, openly authoritarian forces become much more dangerous,” they explain. “Throughout history, cooperation between authoritarians and seemingly respectable semi-loyal democrats has been a recipe for democratic breakdown.””
“They’re more conservative than other Republicans. More likely to be men. Less likely to have graduated from college.
And they’re way more confident they’ve made up their minds, even though the first primary or caucus is still four months away.
That’s the coalition former President Donald Trump has assembled in asserting his dominance over the Republican presidential primary.”
“Back in 2016, Trump ran away with the Republican nomination despite a crowded field of candidates, many of whom had real religious bona fides. Texas Sen. Ted Cruz (R-Texas), a member of a Southern Baptist Church in Houston, often quoted scripture during his stump speech. Marco Rubio (R-Fla.) tweeted a Bible verse a day. Yet, despite lack of any religious credibility, Trump won half of the votes of Republicans who attended religious services weekly in 2016, while Cruz only got only 30 percent of their votes and Rubio earned 11 percent.
That was significant, but it would have meant little had he not earned huge support from Republicans who weren’t religious. During the nomination process, two in five Republicans described their religious attendance as “seldom” or “never” according to data from the VOTER Survey, a longitudinal study sponsored by the Democracy Fund that repeatedly interviews thousands of Americans. Among those who said that they never attended religious services, two-thirds were Trump voters in the 2016 Republican primary. Cruz, by contrast, managed just 16 percent of this group. Among those who described their attendance as “seldom,” Trump secured 57 percent of the vote while Cruz only tallied 22 percent.”
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“In 2016, 39 percent of all Republican voters attended church less than once a year. In comparison, just 36 percent said that they attended religious services at least once a week.”
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“In 2008, 44 percent of Republicans reported that they were in church at least once per week. By 2022, that number had slipped to just 35 percent. In comparison, the share of Democrats who attended weekly only declined five percentage points (23 percent to 18 percent) during the same time period.”
“On abortion, on health care for transgender people, even on mental health care, the candidates were comfortable flexing governmental authority to dictate the terms of medical treatment.
But when it comes to using that same authority to protect people during a global pandemic or providing health coverage to people with low incomes, they don’t want the government getting involved.”
“The poll, conducted by the Times and Siena College, found that “majorities of Republicans side with Mr. Trump on almost every issue” but “those majorities are often quite slim.”
To tease out more who makes up the modern conservative electorate, the Times divided Republican and Republican-leaning voters into six categories, defined by their feelings about the former and would-be-future president as well as their policy positions:
The Moderate Establishment (14%). Highly educated, affluent, socially moderate or even liberal and often outright Never Trump.
The Traditional Conservatives (26%). Old-fashioned economic and social conservatives who oppose abortion and prefer corporate tax cuts to new tariffs. They don’t love Mr. Trump, but they do support him.
The Right Wing (26%). They watch Fox News and Newsmax. They’re “very conservative.” They’re disproportionately evangelical. They believe America is on the brink of catastrophe. And they love Mr. Trump more than any other group.
The Blue Collar Populists (12%). They’re mostly Northern, socially moderate, economic populists who hold deeply conservative views on race and immigration. Not only do they back Mr. Trump, but he himself probably counted as one a decade ago.
The Libertarian Conservatives (14%). These disproportionately Western and Midwestern conservatives value small government. They’re relatively socially moderate and isolationist, and they’re on the lower end of Trump support compared with other groups.
The Newcomers (8%). They don’t look like Republicans. They’re young, diverse and moderate. But these disaffected voters like Democrats and the “woke” left even less.”
The “right wing” and the “blue collar populists”—which make up a combined 37 percent—are loyal Trump supporters. The others in the coalition have more mixed or even negative views of Trump.”
“First passed in 2003 under President George W. Bush, PEPFAR is a vehicle for distributing HIV/AIDS drugs to people in poor countries who wouldn’t otherwise have access to them. It has been astonishingly effective: The most recent US government estimates suggest it has saved as many as 25 million lives since its enactment. It is currently supporting treatment for over 20 million people who depend on the program for continued access to medication.
Given its success, PEPFAR has historically enjoyed bipartisan support. In 2018, Congress reauthorized PEPFAR for another five years without a fuss. But this time around, things look different. Some House Republicans, prodded by an array of influential groups, are threatening to block another five-year reauthorization. Their argument is pure culture war: that PEPFAR has become a vehicle for promoting abortion.
In reality, PEPFAR is legally prohibited from funding abortion services, and the argument against the program on anti-abortion grounds is very thin. But in today’s political climate, where the culture war reigns supreme on the right, this is enough to jeopardize the continued good functioning of a program that the Republican Party used to champion.”