In a bold stand for freedom, personal responsibility, and not reading the discharge paperwork, many Republican-led states continue to pioneer an exciting new approach to public health: making sure citizens are protected from the dangers of affordable medical care, boring safety regulations, and the terrifying possibility of living too long.
For years, the United States has proudly maintained some of the worst health outcomes in the wealthy world, proving once and for all that just because other countries have longer life expectancy, lower infant mortality, and fewer preventable deaths does not mean they have freedom. And within this already grim national picture, Red (Trump supporting) states have been working overtime to widen the gap, posting worse numbers on COVID deaths, maternal mortality, infant mortality, chronic disease, and overall life expectancy.
A major 2024 study, “The Mortality of Politics: An American Paradox,” found that COVID mortality, maternal and infant mortality, and life expectancy were all strongly correlated with how Republican a state votes. In perhaps the least shocking plot twist since Jaws, the states most committed to denouncing public health interventions were also the states where more people died. Researchers estimated that if red states had matched blue-state vaccination rates, 72,000 deaths might have been avoided—which is, admittedly, a very elitist way of measuring success.
But the gap did not begin with COVID. Back in the early 2010s, life expectancy across the U.S. was more or less stable, before beginning a clear partisan split around 2014–2015. Since then, states with more liberal policy environments (things like Medicaid expansion, higher minimum wages, stricter tobacco laws, stronger seat belt enforcement, and firearm regulations) have generally seen health outcomes improve or at least hold steady. Meanwhile, states pursuing the rugged individualist model of governance have seen gains stall, flatten, or reverse. Red states have also been hit harder by opioids, suicide, and alcohol-related disease, while states with more liberal policies have managed the unglamorous feat of improving the odds of keeping more residents alive.
Meanwhile, one of the right’s favorite pandemic fan fictions—that COVID vaccines were secretly causing healthy young people to drop dead—has run into a rude obstacle: data. A huge study found no evidence the vaccines increased sudden death in younger healthy people. In fact, vaccinated people appeared less likely to die suddenly, which is awkward news for everyone who got their medical information from a Bro in wraparound sunglasses yelling on multiple social media platforms about “just asking questions.” So once again, the virus was dangerous, the vaccine was helpful, and the loudest people on the internet were just performing community theater in the genre of preventable tragedy.
Trump, never one to let consistency ruin a disaster, both bragged about the vaccines and helped create the political atmosphere in which much of his base learned to fear them. And this is where the story goes from tragic to darkly predictable: when public policy is driven by unfounded fear, ideology, and cynical performance art, actual human beings pay the price. Not abstract human beings. Not “coastal elites.” Not nameless statistics in a chart. Actual residents of actual states: many of them in the very communities most heavily targeted by the people spreading this nonsense.
So yes, the Make America Healthy Again crowd may keep cashing checks, booking interviews, and selling wellness-flavored distrust to their audiences. But the consequences will not be evenly distributed. Blue states, for all their problems, tend to have higher vaccination rates, stronger public health systems, and policies that more often treat life expectancy as something worth improving. Red states are more likely to be where the bill comes due.
Which means the cruelest twist of all may be this: the cynical opportunism of anti-vaccine politics will probably hit Trump-supporting states hardest.
