The upper middle class benefits a lot from the current system of access to health insurance.  They are more likely to have jobs that provide health insurance that they can easily afford, and they benefit favorably from the tax treatment of these workplace benefits.  So, it is fair to assume that the majority of these individuals do not support changes to the health insurance and health care status quo.  But the question on many people's minds is whether the unveiled contempt for the professional elite will impact their health care status.

The election of Donald Trump as President of the United States and a majority Republican House and Senate all but ensures changes to health insurance and health care policy in America.  What those changes will be is anyone's guess. Does it mean a cap on pre-tax health insurance premiums that most benefit the upper middle class?  It could since there is bipartisan support for such a change.

But I'm betting it won't be for several reasons. One, Trump supporters have yet to articulate what health care reform should look like. Two, most Trump supporters don't understand health insurance or the health care industry well enough to suggest any meaningful changes to them. And, three, many middle class people rely as much on workplace health insurance and its favorable tax treatment as the elites they hate.

But what is the point of beating the elites in a national election, if you can't also make them suffer?

Will Hate Trump Logic?

Many in the middle and lower-middle class hate the educated, professional class to the point of wanting revenge against them for some perceived harm. Who knew? I didn't.  As a former municipal government manager, I remember the cold reception I got from blue-collar workers my first days (weeks, months, years) on the job.  The very visible contempt they had for this "girl" straight out of grad school telling them that their health and retirement plans needed to change because they were too expensive.  The audible grumblings of how they performed all the real work while eggheads like me told them what they could and could not do and decided on their benefits and pay.

But that was 20 years ago, and I never knew that these raw feelings would lead us to this point in history.  And, if I am totally honest, I didn't realize that this election was as much about disgust for professional, educated "elites" as it was any other issue.  It wasn't until after last week's vote, after reading countless comments from Trump supporters that I realized that they hate the professional class and in particular, the highly paid, highly educated, well-connected professional classes. These people are their bosses.  They look down on them, or so they think, and now they want to take away the things they value most, even if that means they lose also.

But What Do They Really Want?

We don't yet have the full demographic makeup of Trump voters, but it's probably safe to say they do not make up a majority of the upper middle class.  Also, we already do know that many of them represent working, middle to lower-income classes.  We also know they hate the elites, and they tend to define elites based on their profession and education as well as where they live.

They don't have issues with the very rich like Trump because they don't know anyone like him. They do know the professional elite because they work for them and now they want to have their say. That want to show them what's what. But what exactly is that? Do they want to have a say in policy issues like health care, outside of we want to pay less for it? Do they understand that if their workplace health insurance loses its pretax status, that they will also pay more in health insurance premiums? Do they understand that repealing Obamacare and replacing it with a program that continues to cover those with pre-existing health issues will cost more without government subsidies? Do they understand that expanding health savings accounts helps the professional elites they hate and not so much themselves?

Wanting change but not knowing what they want it to look like is the downfall of the middle- and lower-income classes when it comes to health insurance and health care policy. The upper middle class is years ahead of them in thinking about what proposed health care policy changes should and should not look like. Elitism has won because that is what it does.

Tags: obamacare, Trump, Upper middle class