In this Trump enclave, a pining for Obamacare?

Just months after joining most of her neighbors in supporting President Trump at the polls, Ann Standridge finds herself in an odd position: longing for Obamacare.

The 59-year-old grandmother says she has an independent streak as hard as any Georgia granite. That’s why, even though she at times could have used the help, she never signed up for any government assistance program through a long nursing career.

But recently, state child-welfare services threatened to take away her daughter’s children because of her daughter's addiction issues. With a deep breath, Ms. Standridge quit her job as a nurse to accept the guardianship of two young tow-headed boys, Atlaz and Anakhin.

The boys are covered under Medicaid. But for the first time in her adult life, Standridge has joined the ranks of the uninsured. “It’s like my name,” she says, smiling. “I feel like I am standing on a ridge.”

So as President Trump and House Republicans work this week to end the Affordable Care Act as the nation knows it, Standridge admits she's looking into whether she’s eligible under the same law her candidate has vowed to repeal, hoping for a subsidized plan that would steer her and her husband through this rough patch.

Under the Republican plan in its current form, she would likely stay uninsured, given that the nonpartisan Congressional Budget Office says premiums would cost as much as half her annual income by the time she reaches age 64, the year before Medicare kicks in. The per capita income in Glascock County is $18,921.

Standridge would view that a broken promise by Mr. Trump, who said during the campaign he would make insurance cheaper and more widely available to a lot of people like her, she says. It also would have a drag-down effect on an already struggling rural, white, and poor county where 90 percent of voters chose Trump – one of the largest margins of any county in Georgia.

“More people would be suffering” if the ACA is replaced with the Republican plan, she predicts, cradling Atlaz. “And a lot of people would be regretting their vote for Trump.”

The voters hit the hardest — those who would receive at least $5,000 less in tax credits under the new GOP plan – are the ones that a recent Politico poll found supported Trump by a margin of 59 to 36 percent. And independent analysis shows that rural, white, aging communities like Glascock County are ground zero for the impact of the American Health Care Act (ACHA). Premiums would rise above the reach of many, even as the plan slashes Medicaid benefits for drug addiction and mental-health care.

“The people who are going to be hurt the most are the exact demographics who voted for Trump,” says Nancy Nielsen, a clinical professor at University at Buffalo, and past president of the American Medical Association. The Republican plan is “helping the wrong people” because it achieves its goals on the backs of poorer Americans.

“When you move from income-related health to age-related health, you really help those who often don’t need it, which are younger people who are middle class, have good jobs, and will have the same opportunity for the tax credits as somebody working at a fast-food restaurant, if they’re the same age,” says Dr. Nielsen.

Trouble ahead for rural America

Rural Americans will also be particularly hard hit because there’s little competition to drive down prices from doctors, hospitals, and insurers. And poorer and older people would likely see the biggest cuts in government help to be able to afford health care.  

With the largest chunk of Glascock County residents in the 50-to-64 year old age group, 1 in 4 residents are already on Medicaid or other government benefits. Many others are on Medicare disability, a fact of which they’re not necessarily proud. “Don’t mention that I’m on disability,” one middle-aged county resident asked during a brief interview at Jet, gassing up a truck.

Asked if he’s paying attention to the health-care debate, he says, “I am. And I’m looking at it from both sides.”

To be sure, Trump’s staff has suggested changes. Health and Human Services Secretary Tom Price, a former Georgia congressman, told CNN over the weekend that the Republican plan – and Trump’s campaign promise to have “insurance for everybody” – must be seen not just as the AHCA but the Republican plan “in its entirety.”

“This bill … is simply the first step,” Mr. Price said. “Every American will have access to the kind of coverage that they want.”

But it’s a tough political problem that comes down exactly to how much people in places like Glascock County are really paying attention. One question is the extent to which Glascock County residents view health care as a matter of personal liberty – or as a community benefit that binds them to the plight of their neighbors.

“These people see their communities getting the short end of a stick and they feel Trump can help them, and I’m not sure that a lot of them really include health care as part of that community support portfolio,” says Al Cross, the director of the Institute for Rural Journalism and Community Issues at the University of Kentucky. “There’s an independent streak in rural areas [where] … health care is not a community problem, but an individual one.”

Poor people don't care?

With just 3,000 people – 90 percent white and 8 percent black – Glascock County is 144 square miles of stretching cotton fields. Humble homes and trailers have ATVs, golf carts, and jon boats stuffed into carports. Back yards are turned into rabbit pens and duck hutches. Such possessions, though hardly gilded, are fiercely protected.

“Keep out er [sic] we’ll shoot,” says one hand-scrawled sign on a front porch stocked with lawn mowers and fishing gear.

To be sure, some centrist Republicans are balking, especially at the fact that 14 million people could lose coverage in the first year of the plan. “I've got to be comfortable that the fix [to Obamacare] accomplishes many of the things it says,” says Rep. Darrell Issa, a California Republican whose district is being targeted by Democrats for the 2018 midterm elections.

To be sure, some Republicans aren’t too worried about a revolt from Trump’s rural base. “The poor … is a group of people that just don’t want health care and aren’t going to take care of themselves,” Rep. Roger Marshall, a former doctor and first-term congressman from Kansas, told the healthcare-focused website STAT. He added that poor people are “morally, spiritually,” and “socially” opposed to obtaining health care.

But other Republicans, especially from largely rural states, are rejecting that line of thinking. Kentucky Gov. Matt Bevin last year ran on withdrawing from the Medicaid expansion that many other Southern states rejected. But after he took office, Governor Bevin now wants to reform the expansion, not gut it. The reason: More than 400,000 poorer Kentuckians have coverage today that they didn’t have before Obamacare.

“Wiser heads obviously got to Bevin with a simple message: ‘These voters of ours may not vote for Democrats because they gave them health care, but they will vote against us if we take it away,’” says Mr. Cross.

“The problem for Republicans is they have many different arguments and they’re not consistent,” says John Holahan, a fellow at the Urban Institute’s Health Policy Center in Washington. Some GOP lawmakers want government involved in health care. Others believe officials should reduce subsidies. Still others want more subsidies so their deductibles go down.

Catfish and Confederate flags

A visit to Gibson illuminates the tension.

Dominated by a Dollar Store and a mobile home parts store, it’s a tight-knit community where the local diner serves fried catfish and the nicest restaurant in town is named the Heritage House – and flies the Confederate battle flag just below the Stars and Stripes.

The local tanning salon is by appointment only, and may be one of the few beneficiaries, at least in this town, of the AHCA: The Republican plan would end Obamacare’s excise taxes on tanning salons.

Bob Brooks, who works in a manufacturing plant about an hour’s drive away, moved to Glascock County nearly two decades ago for the easy-going lifestyle, low crime rate, and a decent school district.

“It’s a friendly, hard-working, good-hearted place,” he says. But when it comes to health care, he says, “people can’t afford it, so they get sick and don’t go to the doctor. This is happening every day in this county. That’s real life right there.”

Obamacare, he says, is part of the problem, which is why Trump’s message resonated. The individual mandate, the tax penalty for not signing up, was unpopular here. And in order to pay for more vulnerable Americans, premiums rose – meaning many here couldn’t afford out-of-pocket medical care.

But despite Obamacare’s flaws, Mr. Brooks says Trump “has to stop” the Republican plan in its entirety. Achieving Republican goals of deficit cutting and yanking away any hope of relief is a mistake, he argues.

“Trump’s got to do something about this,” he says.