The Iowa counties that benefit the most from the Affordable Care Act also overwhelmingly voted for President Donald Trump last fall, according to U.S. Census data and election records.


The juxtaposition of the benefit from the Affordable Care Act and support for Trump hasn’t gone unnoticed, said Dennis Goldford, chair of the Political Science Department at Drake University in Des Moines.


“Many of the Trump (voting) counties in Iowa are rural and small, and traditionally Republican,” Goldford said. “Studies have shown that in counties like that around the country, if you ask a Trump voter if they are for Obamacare, they say no, but then if you ask if they’re for the affordable healthcare bill, they’ll say yes.”


Of Boone, Dallas, Story and Polk counties, Story has the lowest per capita income at $25,450, according to the 2010 census. However, the percentage of people in Story County insured under the ACA is only 4 percent, compared to Boone, Dallas and Polk, which all have around 6 percent participation in the plan.


While Boone County’s per capita income is similar to Story County, at $25,998, it has 2 percent more of its residents enrolled under the ACA. Voting records show Boone County had a 20 percentage point edge over Story County in the voters who supported Trump, who campaigned on and has continued to push for the repeal of Obamacare during the early months of his presidency.


Dallas County, which has a per capita income that is $8,000 higher than Story County, also has a higher percentage of people enrolled under the ACA, while also supporting Trump in last November’s election.


Story County was one of only seven counties in Iowa to vote Democrat in November while also having the least at stake should Obamacare be repealed compared to other, more rural, Republican leaning counties.


“Many of those (small, rural, traditionally Republican) counties are fairly poor, and qualify for various government subsidies,” Goldford said.


Those subsidies include premium caps based on income and other cost assistance programs aimed at helping Americans with lower incomes afford healthcare. If the ACA were to be repealed, those subsidies would go away. In Iowa, the majority of those income groups reside in counties that voted for Trump.


“They may not have known what they were getting themselves into,” Goldford said of Trump voters who benefit from the ACA remaining law. “We will have to wait and see.”