Donald Trump campaigned for president on a promise to “repeal and replace” Barack Obama’s Affordable Care Act. Once elected, his administration began the “almost unimaginably dysfunctional process” of fulfilling this promise (121), but the “constant theme” of these efforts involved “negative consequences for Southern white working-class populations” of Trump’s base (121). Publications like the New York Times, Mother Jones, and the Wall Street Journal described what Trump supporters had to lose from the various incarnations of “Trumpcare,” detailing how many people might become uninsured or how insurance plans might become less comprehensive.

Initially, commentators assumed that Trump’s attempt to repeal the ACA would fail because “political loyalty would change when [voters’] well-being was at stake” (122). However, research that Metzl conducted in Tennessee in the years preceding Trump’s election illustrated how “the burden of centuries of history“ affected voters’ concept of “government intervention in general, and into healthcare specifically,” along with its connection to “xenophobia and racism” (123).

Between 2012 and 2016, Metzl and a team of colleagues assembled focus groups of white and African-American men across Tennessee. Their goal was to learn about their opinions regarding health, the ACA, and government intervention in healthcare.