Obamacare Medicaid expansion was adopted by West Virginia, the expansion now covers 173,600 working poor and their families not previously eligible for Medicaid, with the federal government covering 90% of the cost. Trump, of course, and every Republican candidate planned to end it. 

Hillary's infrastructure plan would provide jobs in the region. As in many parts of the country, if a sole employer or industry leaves or disappears, people may have to leave small towns to go where the jobs are.

I would say I have known and worked side by side with people from this region. Some I called Master Chief, one I worked with doctor and another was one of the best carpenters I have ever had the luck to have work done by.  A few were lacking in basic education when I served with them in the navy. No one there called them white trash. 

Maybe the nation needs mandatory national service of some form, so we learn to respect each other. Some skills might be learned in the process.

J.D. Vance, who escaped the poverty and hopelessness of Appalachia, wrote about the plight and mindset of the region in "Hillbilly Elegy". Vance joined the Marines, attended Ohio State, and graduated from Yale Law school. His analysis of his hometown region is that people have lost hope, trust in government, and are less religious. He contrasts this sad state of affairs with the hope and pride in country he got from conversations with his grandmother when he was a child. People in Appalachia feel that they have been left behind.

In the book, Vance notes that deaths by suicide and drug overdoses have increased. People have fallen behind and they have lost faith that the country cares about them. They lack trust in both parties. When Vance talks about the suspicion residents have about the Obamas, he tries to minimize the racial aspects. He accurately points out that Appalachians were suspicious of GW Bush and the Republican elite. One difference between Bush and Obama is that a high number of white Republicans do not believe that President Obama was born in the United States. Republicans believe that Obama is a Muslim.

Church attendance is actually down for non-educated whites in Appalachia, College educated whites in the region are much more likely to attend church regularly. This gap is important. When Trump gals about religion and uses "Two Corinthians"' rather than "Second Corinthians" it does not clash the eardrums of a person who does not attend church.

Link to the book review at the WaPo

https://www.washingtonpost.com/opinions/a-hillbillys-plea-to-the-white-w...

Link to an interview at NPR

http://www.npr.org/2016/08/04/488637593/hillbilly-elegy-author-on-the-wh...

The voters are ripe for the picking by Donald Trump.

So I wrote a very long essay about class and American politics but failed to get it published anywhere (though I did receive a very nice rejection letter from the New Yorker).

The gist was that there are two fault lines in American politics, race and class, and we keep oscillating from one to the other. The class line first came to fore in the 1820s when Andrew Jackson led an insurgency against the elitist Democratic-Republican Party. His supporters founded the Democratic Party to represent the masses; the Whigs roses from the ashes of the Dem-Repubs to represent the elites.

But then race came to the fore in the 1850s. The new Republican Party represented abolitionism; the Democrats came to represent slavery. Class receded into the background.

The next transformation happened in the early 1900s, as populist class insurgencies shook both parties. After Theodore Roosevelt bolted the GOP in 1912, Democrats came to represent the masses again. Republicans represented the elites. Race receded into the background.

Then in the 1960s, race returns. Democrats become the party of equality and integration. Republicans become the party of white resentment. Class recedes.

Now here we are in the 21st century, and class has returned. Populist class insurgencies have once again shaken both parties. The Democratic insurgency mimics the early 1900s--pro-labor, anti-Wall Street. The GOP insurgency looks more like Andrew Jackson's revolt--xenophobic and nationalistic.

One way or the other, the two parties will once again divide along class lines. But which party will represent the elites and which the masses? At this point, it's looking like a working class Jacksonian GOP vs technocratic, elitist Dems. But the show isn't quite over. A plot twist could still flip the script.

Excellent tack, acanuck, because as you rightly point out, the worst possible outcome to an election where Hillary wins is that regions like Appalachia are ignored. My DNA is Scots Irish---which is virtually synonymous with "Appalachian roots", which long before my landing here had taken the Southern route to this poor Texas county I now call home.

The conundrum of politics in Appalachia is that "government" was never liked, the culture consisting of a clan structure and within that, manliness, courage and self reliance. The fact that the R's have denigrated government itself has worked extremely well. A double whammy, and entrapment of their own choosing, on the notion that government can deliver anything of value.There can be exceptions but the impetus to bringing these areas back must be local, not a national program---a least not one which is recognized as such.

For example, in my rural Texas county a large reservoir will be built and there will be development around it. The whole project cuts both ways because we locals see land values and taxes increasing and we know the water will mostly go to support the burgeoning N Dallas metropolitan area. Nevertheless, with good local planning the project can be beneficial to folks here.

Just saying, one size fits all National Programs are not necessarily going to benefit my neighbors here nor my kin in Beattyville, Kentucky.