The Trump administration has flip-flopped on importing drugs from Canada. HHS secretary Alex Azar has always been against it, but he says that Trump has been “pushing” him on the subject. But why? Let me start with a familiar story, this time from the Canadian Broadcasting Corporation:

It was Tara Saunders’s dermatologist who suggested she drive across the border to Canada to buy her medication. The dermatologist called in the prescription to Mark’s Marine Pharmacy in Vancouver. The 20-minute drive from her home in Blaine, Wash., saved Saunders $300 US a month. ….She isn’t the only one making the trek north. Earlier this month, a group from Minnesota, calling themselves the Caravan to Canada, made a trip to Ontario to buy insulin at a tenth of the U.S. price.

These are both states that border Canada. Are you starting to get an inkling of what’s going on? Maybe a map will help:

Trump is focused like a demon on the blue-collar states that won him the presidency in 2016 by a hair, states that he knows could go either way in 2020. Right now it’s mostly people in these border states who are the ones schlepping across the border for their insulin or cholesterol meds, and allowing legal importation would make a concrete improvement in their lives.

Is that a lot of people? No, but when you win a state by 0.2 percentage points, every little bit helps. And you can be sure that Fox News affiliates in these states will be on board with lots of heartwarming stories about someone’s grandma who can now relax and not have to worry about the monthly drive to Sault Ste. Marie or Hamilton that keeps her from having to ration her drugs. This new policy has nothing to do with making health care better. It has everything to do with Trump winning a few more votes in the upper Midwest.