Leah Briemer was recently flipping through old family photos at her Lawrenceburg, Kentucky, home, reliving old memories. Briemer can attest that life’s best moments can’t be taken for granted.
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“Our ‘Leah may not be here next year’ picture,” Briemer said, holding a photo of herself taken in 2015. “That was not a good Christmas.”
Just weeks before that photo was taken, Briemer, a widowed mother of two and a former nurse, was given what she said felt like a death sentence.
“I was diagnosed with stage 4 metastatic breast cancer,” she said. “I had about two or three weeks to live without treatment.”
Briemer was lucky. She was able to start a targeted treatment for her cancer immediately.
“I had some more scans done in February of last year and they found that I was extremely fortunate that the treatment had really worked,” she said.
It was a renewed chance at life, but the treatment is very expensive. Even though it was covered by Briemer’s health insurance under the Affordable Care Act, there’s a chance it might not be an option for her in the future.
“If I didn’t have health insurance, I wouldn’t be alive today,” she said. “I’m on an every three week regimen of medications … that’s about $40,000 a month … so I’m very concerned about the issues that are taking place right now.”
Briemer is one of the millions of Americans who are insured under the Affordable Care Act, also known as Obamacare. Former President Obama announced in March 2016 that an estimated 20 million Americans had gained health insurance since ACA was signed into law six years ago.
But now with the new administration and a Republican-led Congress, the program could be in its last days because current lawmakers say they can come up with a better health care plan.
Much of the criticism of the ACA program are its high premiums. But Briemer’s home state of Kentucky, the land of bluegrass, bourbon, horse racing and coal mining that went for Trump this past election, has been held up as an example of Obamacare’s success.
Since the Affordable Care Act became law, there has been a startling drop in the uninsured rate in Kentucky. Some areas have gone from 20 percent to less than 10 percent uninsured. Much of that is credited to the law’s Medicaid expansion, which provided some half million low-income Kentuckians with coverage since 2013.
Whitesburg, Kentucky, is a quiet town nestled in the Appalachian Mountains and close to the Virginia border – coal country. It has a population of 2,100 and a deep history of hard work and perseverance.
“Around here you keep a job and you do as they say no matter what because you’ve got to work to survive,” said Mike Taylor, a former coal truck driver.
Coal has been at the heart of the local economy for generations, but it’s also the root of health issues for many.
Taylor was diagnosed with “Black Lung,” a deadly lung disease caused by breathing in coal dust, in 2015. He is on three different inhalers and uses an oxygen tank and a nebulizer machine.
When he gained insurance through the ACA’s Medicaid expansion, he began seeking regular care at Mountain Comprehensive Health Corporation, a community clinic where his physician, Dr. Van Breeding, also happens to be his old high school classmate.
“These people need care,” said Breeding, a primary care physician. “I take care of classmates of mine everyday … people who I went to kindergarten with who are disabled now, who can’t work. So imagine you’re 55 years old and you’re worn out.”
“And these are the people who have been helped by the Affordable Care Act and these are the people who we can’t turn our backs on,” he added.
Breeding believes the ACA is crucial to the health of his community. His father was a coal miner, he said, so he is all too familiar with the toll Black Lung disease can take.
“We're seeing that it's a political war over health care and the collateral damage is the patient's health and life and the quality of life,” Breeding said. “Change the name if ‘Obamacare’ is offensive to Republicans, change the name, and call it what you will, but provide these people who are desperate, and I mean desperate, desperate for some type of health care.”
Taylor said the health insurance he has under ACA not only saved his life, but also helped his brother-in-law and his former coworkers.
“It’s a good thing to have it. The insurance,” he said. “I think they just need to reform it.”
The success of the ACA in Kentucky in due in part to robust outreach programs. Kelly Oller is one of many outreach workers dispatched across the state to educate and enroll follow Kentuckians in health insurance.
“I like helping people and then signing people up and seeing the joy on their faces when they get affordable insurance,” Oller said.
As a Trump voter, Oller is an unlikely evangelist for Obamacare. She said she has signed up more than 1,000 people in the last three and a half years. But as open enrollment for Obamacare coverage for 2017 drew to a close on Jan. 31, Oller knows its future was unclear.
Before the January deadline, Oller tried to enroll Danny Lock, who said he hadn’t had health insurance for several years and credited simple luck for having never gone to the hospital. But at the end of his application process, the ACA’s enrollment website healthcare.gov was showing he would owe premiums of almost $400 a month.
“Nobody can afford that,” Lock said.
This issue is happening not just in Kentucky but across the country. For many Americans like Lock, Obamacare premiums are simply too expensive.
“I’ve seen the hurt and disappointment of not being able to obtain insurance when his whole life he always had insurance through employment,” Oller said. “He's not able to afford signing up for coverage, and that really hurts my heart.”
Fixing the high premiums in Obamacare is one of the changes Oller was hoping for when she voted for President Trump.
“I thought he was looking to repeal it to make it better, to make it more affordable and to make premiums hopefully go down and be balanced,” she said. “I don’t know what’s going to happen now.”
So far there have been few specifics from the White House or Congress on changes coming to the health care system, leaving people anxious about the future of their coverage.
Last week, a cacophony of concerned voices around the country, from Kentucky to Arkansas to Florida, cried out at town halls, demanding answers from their Republican leaders on affordable health care options.
In Kentucky, one of the law’s most vocal critics is the state’s current governor, Matt Bevin. His predecessor, Democratic Gov. Steve Beshear, embraced the ACA. So when Bevin, a Republican businessman and retired U.S. Army captain, took office in 2015, he began focusing on dismantling the state version.
“I thought it was a disaster from the beginning. No question,” Bevin said. “One size does not fit all in anything, certainly not in something that is as critical as health care that is necessary for people to have access to.”
Bevin criticizes the high costs of Obamacare and is a staunch opponent of federal mandates. Currently, under the ACA program, people who can afford health insurance but choose not to buy it must pay a fee.
“Let's say you're a single parent and you're making $30,000 a year,” Bevin said. “[You’re] required to have health care coverage now under the Affordable Care Act. Do you really think that you can afford to pay $6,000 in after tax dollars for your health care for you and your family? No.”
Bevin said a lot of the fear from the public over losing their coverage at all is “ungrounded in reality.”
“There's nobody in America that I'm aware of, certainly no governor, Republican or Democrat, certainly nobody in the federal administration at the congressional level that I know of that is looking to make people less able to avail themselves of the health care system,” he said. “Everybody's looking for a solution.”
Bevin’s main argument echoes the voices of many Republicans in that health care should be handled at the local level, without mandates from Washington.
“I say trust the governors,” he said. “I say give control to the governors and the legislatures within each respective state.”
It’s those federal mandates that Bevin says have led to “less than desired” results in his state.
“Simply having health insurance does not make you healthier,” he said. “If you have a Medicaid card, but you can't find a doctor that will see you, how does that Medicaid card help you? You can't eat it. It's not vitamins. I'm being a little facetious. But truth be told a piece of plastic doesn't make you healthier.”
Bevin is proposing controversial changes to the state’s Medicaid expansion program. His plan includes having Medicaid start charging a small monthly premium for coverage of “able-bodied adults” -- coverage that is now mostly free -- and it would also allow the state to cut off Medicaid coverage to those who don’t pay the premium, which he called a “lockout” provision. Bevin also proposed that his plan would offer the opportunity for people to earn “credits,” which could be obtained through volunteering and could be used toward other benefits, such as dental and vision coverage.
But critics of the plan say this is yet another barrier for a population that is already struggling.
“They're barely getting by on what they do have,” Dr. Van Breeding said. “To create more barriers is going to cause them to have worse health than they have."
“We already have some of the most unhealthy people in United States in this area and a lot of it is because they're too proud to take a handout or to take free care,” Breeding continued. “And when they got insurance now they have legitimate health care, legitimate insurance. They've come in and not only come in for health problems but preventive measures.”
As the country waits for a full picture of what’s to come next, many like Leah Briemer fear they may lose the safeguards that have protected them, such as coverage for people with pre-existing conditions.
“Of course I worry about if my cancer were to come back what would happen, but now I have to add to that what would happen if I lose my health insurance,” she said. “My daughter’s 18. She’s graduating from high school. I need to be here for my daughter. Help her get through college. Help her have a wedding. See my grandchildren be born."
She went on, “When something’s working for so many people and you decide you’re going to take it away. And you say it’s horrible, it’s not working for anyone, even though it is, yeah that’s playing politics with my life and many others."