Rural Realities of Repealing the ACA

My husband woke me on election morning, flipping on the hallway light and walking into the living room where I’d been sleeping.

“What time it is?” He didn’t answer as I fumbled for my glasses.

Later, I’d find out it was 2 o’clock. Our alarm goes off just after 4 am.

He sat down next to me, cradling one hand with the other. “I think I may have fucked us over with good intentions.”

It was not a white male premonition for how the election would end twenty-four hours later. He’d gone outside around 9 o’clock to transfer that day’s yogurt making from incubation to refrigeration and passed the barn’s wide-open garage door on his way back to our trailer. I have a moderate case of Raynaud’s Disease, which causes the blood supply to my fingers to decrease, particularly on chilly, drafty mornings. He’d decided to close the garage door, keeping some of the heat from our fifty-cow herd in the barn to make my morning milking better. He’d done so in the dark, not able to see that his hand was placed in the track. He’d crushed three of his fingers beneath the wheel.

We examined his swollen, purple fingers in the lamp light. Two were numb. One was too swollen to bend. He’d fallen asleep, but woke up after midnight in excruciating pain.

“Want me to take you to the ER?”

He flexed his hand, winced. “I don’t think they’re broken.”

“Want to put ice on it?”

“I already put frozen corn on it before I fell asleep.”

“Advil? Aspirin for the swelling?”

“I think it’s in the car. Don’t bother getting it.”

“Toast? Do you want toast?”

That finally made him pause. “Yeah, I’ll take some toast with jam and butter.”

I made me coffee and him toast. Eventually, he fell asleep and I went out to the barn early to start morning chores to compensate for him being down one hand. I fed cows hay and molasses, filled the feed cart, scraped and bedded the barn before starting to milk at 5:30am.

Despite me joking that he couldn’t vote with a finger injury, we drove to our polling station after milking and cast our ballots.

It wasn’t a pleasant morning, but it wasn’t terrible, either. Despite working on a small dairy farm, we have health insurance through the Affordable Care Act. Had his hand gotten worse through the day, I’d have scheduled a sixty-dollar office visit with our GP or gone to one of the urgent care facilities in town, which are more expensive, but address issues more quickly.

It’s now two days since Donald J. Trump was elected to be the next president of The United States with both the Senate and the House of Representatives remaining in Republican control. I know the peace of mind given by the ACA will soon be gone and not just in regard to crushed fingers.

My husband and I work for a small business in the agricultural sector with less than ten employees. It was formed in 2008 and is still a growing, struggling operation. We’re paid a living wage plus housing for our sixty to seventy hour work weeks, but the owner is unable to offer health insurance. It is the ACA that allows us to both work for a small business and have affordable healthcare.

We work with cows every day, animals I trust and love. Gentle giants can still be dangerous. Over the past eight years, I’ve been knocked down by a steer trying to mount me, carried through the barn then dropped beneath the hooves of a stampeding dozen, and, most recently, thrown down on a cement pad, skidding on my elbows and the bare skin of my back after standing behind a fight between Jelly Bean and Mica.

Danger comes with the work, as it does for all farmers. In addition to animals hazards, we are surrounded by large equipment, noxious fumes, chemicals, all manner of weather conditions, and long, grueling days. I’ve also been shocked by lightning through an electric fence and smashed in the shin with a sledge hammer. These incidents have proven to me how invaluable the Out-of-Pocket maximums are to people who work in high-risk environments. We can go about our work bravely, unafraid that one slip up will ruin our family’s finances.

As the saying goes, farmers are land rich and money poor. Wealth is tied up in their land and operations, leaving little liquid for themselves and their family. My parents ran a dairy operation for twenty years. The only expense they talked more about than property taxes was health insurance to cover our family of four. They managed our small household budget tightly, making sure we were well cared for, despite second hand clothes, discount glasses, and no vacations.

We were luckier than our neighbor who wasted away from stomach cancer without health insurance to aid him. Even now, I see a healthcare void in the agricultural community. A visit to the weekday hay auction shows you farmers with teeth rotting out of their mouths, pronounced limps, maimed fingers, asthmatic wheezing from a life of inhaling hay and dust. These are fiercely independent individuals, old men who want the government out of their lives until milk prices drop or the corn suffers from drought. They bitch and whine all the way to The Farm Service Agency where they sign up for crop insurance and government-sponsored loans. I have no reason to see why their opinion on the ACA will be any different, loathed until it is no longer available.

I worry for my community, but I also worry for myself. We were college graduates in the mid-aughts, young people driven to get an education in fields we loved with the promise of gainful employment for our student loan investments. The reality of the economic landscape was in stark contrast to the hopes we had.

For us, and for so many older Millennials, we’ve had to carve our careers from the margins. Classmates and friends of mine have gone on to start CSAs, carve and paint historic bows, compose scores for video games, teach violin lessons, do contract web-design, perform in multiple orchestras. Many have gone on to find normal careers, many have not. For those of us who haven’t, the ACA was a life-changing bill. We were able to take struggling careers and legitimize them, stabilize our lives and plan our futures. When politicians speak about about supporting small businesses, they focus on decreasing tax rates and low-interest loans, forgetting that small businesses are started by people who first need to ensure the safety of their families and lives.

My husband and I now face this reality as we plan for a future without the ACA. For years, we’ve been planning on starting our own small agricultural business, renting land farmed by my family for three generations. We’ve been saving money, writing business plans, raising a herd of our own. Without affordable health insurance, this is something we’ll be unable to do together. One of us will have to reenter the workforce, seeking full-time employment with sound benefits. We’ve had insufficient health insurance plans in the past. During one of our lowest financial points, we spent almost $20,000 for three years of coverage. During that time, we went to the doctor twice and had charges of over $75 both times. We rarely used our benefits because, despite insurance, the cost was too great for our tight budget. I often wondered if we’d have been better off putting that money towards our student loans, yet know from experience that not having health insurance can be devastating.

We’ve been using our health insurance more frequently in the past year and a half, catching up on dentist appointments, monitoring my husband’s genetic disposition to high blood pressure, having my first pelvic exam in six years. The reason for this has been twofold. First, we’re finally getting to a financial place where we have the luxury of spending money on preventative healthcare. Second, we were talking about having a child. For most of our marriage, we’ve viewed parenthood as a financial impossibility, joking that we are economically infertile. It’s only been in the three years since I’ve turned thirty that we’re becoming secure enough to contemplate having a baby. Though I’d like more years during which to plan, I’ve been facing down the biological reality that I only have so much time. Before the election, we were reviewing plans on the healthcare exchange with this future in mind, comparing prenatal coverage and delivery fees. We’re now thrust back to square one, deciding whether or not we can afford to have a child and provide it with the financial security a family needs.

The planned repeal of the ACA has placed us in a world of uncertainty for our financial future, our agricultural future, and our family’s future. Despite this, in spite of this perhaps, I know I am privileged. My husband and I have college educations. We have solid work histories. One of us will be able to find a full-time job before the end of 2017. We may have to abandon plans we had for our future, but we will continue to survive. I mourn the loss of possibility, of promise, of our pursuit of happiness. For us and for the 22 million other citizens who will lose their health insurance upon the repeal of the ACA, this doesn’t feel like the American dream.



  1. Absolutely devastating…my family and I have lost our insurance as well. This repeal is estimated to take away health insurance from 40 million people, 4 million of which are children. Harvard School of Public Health estimates 26,000 deaths this year…

    Liked by 1 person

  2. I am so sorry to hear this! I am a stay at home mom and know the realities of revamping work/home life to do what is best and most affordable in regards to finances and healthcare. My husband owns a small business and we have a 9&2 year old. I was working part-time as a social worker and quit 6 months after my, now, 2 year old was born. This way we could avoid paying for the unaffordable daycare and qualify for state health insurance. Every year we wait for taxes to be completed to see if we will still qualify for coverage. This year is the scariest it’s been in a long time because who knows what the guidelines will look like😥. From working in social services, I do know something you may want to look into regarding prenatal care. Depending on the state your in, I’m in WI, there may be secondary insurance coverage you qualify for through state insurance when pregnant. I was not aware of this with my first child but it saved a lot of money and stress for my second. I know the hesitance of not wanting to greet a new baby with a mound of debt! Good luck and may Bernie help us all!

    Liked by 1 person

  3. This really sucks. My parents are also farm workers who depend on this insurance, and it will truly hurt them.

    On one hand, I understand people’s anger regarding the rising costs of insurances. It’s not so much the fault of implementing ACA, rather greedy corporations who are taking advantage. I work in corporate where our monthly premium was fully covered by our company. However, this year our company is making us pay the monthly premium bc insurance costs skyrocketed. So I understand people are angry and want to blame someone…

    Just that repealing the ACA is NOT the solution.

    Liked by 1 person

    1. My husband and I pay around $600 dollars a month for both of us. We earn just below the median income for our region. I understand there are limited plan options and rate increases have occurred, though at a lower rate than before the ACA was passed. It has done quite a bit to make *healthcare* more affordable. We need to work on the health insurance aspect of it, either by expanding tax credits or by adding a public option to increase competition and offer more plans. Also, depending on what state you live in, prices are set by insurance companies based on the cost of local healthcare. The effects of the ACA have been minimized in some regions because of state governments. Because insurance is regulated by the state, states that chose not form their own marketplaces haven’t functioned as efficiently.

      Liked by 2 people

    2. Also, I urge you to talk to your senators and congressmen about what plan would work for you. A variety of replacement options are being floated at the moment. Read up on them and be an advocate for your family. Be vocal about your needs.

      Liked by 1 person

  4. There was fierce resistance to FDR’s New Deal, too, from which Social Security became part of the national fabric. You think people want to give up their SS? Please — this is part of people’s retirement plans. As for health care, I went bare for about a year and a half after I was laid off. I was employed after nine months on a temporary basis. Then, I bought my own insurance — a high-deductible, capped policy that I never used; but it made me feel so much more secure. When I was hired into a full-time position, I had a good health insurance plan again. Soon after I got it, I had my regular checkups and my first mammogram in about two years. Two years after that, I had another mammogram and was diagnosed with breast cancer. I know what it means to feel insecure without the coverage. From what I hear, Congress has the bomb health care. We should all have a plan like theirs.


    1. “Congress has the bomb health care. We should all have a plan like theirs.”
      Your point is so valid. I totally agree with you. Millions of us will suffer from the repeal of the ACA while the same people who work so hard at repealing it will still be treated. With our money. Shame of them!


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  6. Always interesting to see posts and discussions like this.
    We live in England where, for all the cricism, the NHS does work pretty well. My wife and I both have medical issues, which mean we depend on it day to day.
    We came from Zimbabwe. When we left medical help was generally very simple: Pay up front in full. If you’re lucky you will get something back in three to six months on medical aid. And the medical aid had to be provided by the employer – I was self employed for quite a few years.
    I have seen both sides. As I get older I really sympathise with your situation.


  7. Your fear is unfounded. Despite what you may have heard (or choose to believe), the ACA will be repelled and replaced with another federal statute that protects against, for example, pre-existing conditions. Several composite bills have already been designed to give consumers more leverage in paying lower premiums. That’s a good thing.

    Moreover, the individual mandate penalty will also go away, which millions are taking advantage now to forego expensive monthly premiums. This year alone the penalty has risen to 2.5 percent of one’s total household adjusted gross income, or $695 per adult and $347.50 per child, to a maximum of $2,085. The flat fee is expected to increase every year to adjust for inflation. Rather than “encourage” people to buy health insurance, it’s essentially forcing them to. The ACA is far from perfect, and it’s time to replace it with a better version.


    1. Since writing this post, I’ve gotten fairly deep into the weeds regarding healthcare policy. The snark regarding what I choose to believe isn’t appreciated. I have read several of the replacement plans floated by opposition to the ACA. First off, it is reckless, poor governance for the House and Senate to be working on repealing the ACA before one concrete replacement plan has been proposed and reviewed by the public. It’s repeal will create a public healthcare crisis, forcing whatever the final replacement plan is onto citizens.

      There are new federal statues being floated. True. However, they have yet to back a single plan. There is a wide divergence in policy. Paul Ryan’s Better Way for Healthcare plan allows insurers to charge sick people and people with preexisting conditions more if they are unable to maintain continuous coverage (for example, if they get sick and are unable to keep their jobs, which give them health insurance). The Center for Health and Economy estimated would cause 4 million individuals to lose their coverage. Additionally, premiums may go down for younger Americans, but they would skyrocket for older Americans.

      It is estimated that under Orrin Hatch’s Patient CARE Act, 4 – 9 million people will lose their insurance. While Better Way for Healthcare gives out subsidies based on age, Patient CARE will give them out based on income. Despite this, it has the same effects of Ryan’s plan. Insurance premiums will rise for older Americans, decrease slightly for younger Americans.

      The Empowering Patients First Act, proposed by Tom Price, the nominee for secretary of HHS and one of the more detailed plans available, repeals Medicaid expansion, its subsidies, its insurance regulations, and its consumer and out-of-pocket protections. This goes against your assertion that they will maintain protection for individuals with preexisting conditions. Also, one of my main concerns is keeping out-of-pocket maximums in place so no one health disaster could destroy my family financially. This happened to my husband’s family when his younger brother suffered from a respiratory crisis in 4th grade, which put him in the hospital for a month. Though my brother-in-law is thirty with two kids of his own, his parents are still suffering from his hospital stay in elementary school. Price’s plan offers a tax credit between $900 (child)- $3000 (51 or older), not nearly enough to provide quality insurance for a family. Maybe insurance will cost less, but it will cover less as well.

      While my husband was working in corporate retail, we estimated that we spent nearly $20,000 in three years on health insurance. In that time, we went to the doctor twice and were charged $75 dollars both times. The protections and price of healthcare under the ACA have been far better quality for a similar price. I’d also like to note that while premiums have been increasing, they have decreased at a LOWER rate since the ACA was passed. The largest single increase in the last decade occurred before President Obama was in office.

      I will admit that the ACA isn’t a perfect plan. I won’t reiterate my response to a previous poster regarding this, but you can look at it. I would be in support of adding lower cost catastrophic-type plans for individuals who don’t feel as though they need much healthcare. They should offer preventative care and total yearly out-of-pocket maximums to aid people from going bankrupt because of healthcare catastrophes. The ACA has lowered the cost of using healthcare for millions of Americans, though the cost of insurance has increased. Perhaps they should leave the Affordable Care Act in place and try to structure an Affordable Health Insurance Act instead.


      1. In addressing your concerns, my intent was not to be inflammatory or derogatory in any way. There are simply those who say “bad things” will happen, and others who predict “good things” will happen. The bottom line is we won’t know for sure until a replacement goes into effect.

        You cite a number of possible drawbacks to Paul Ryan and Tom Price’s plans, in particular that an estimated four to nine million people will lose their insurance. Keep in mind that over eight million people have chosen not to purchase a policy (including some of my own friends and family). They’re instead opting to pay the fine required by the individual mandate. That’s a total of $1 to $3 billion in penalties.

        You also expressed concerns about losing Medicaid expansion and protection against pre-existing conditions. The Supreme Court already ruled in 2012 that the federal government could not require states to expand Medicaid; states must decide on their own whether to expand it.

        Trump has nonetheless guaranteed nothing will adversely affect Medicaid. Even during the Health and Human Services Secretary Confirmation Hearing (HHS) when Senator Bernie Sanders asked Representative Tom Price (R-GA): “So you are telling us that to the best of your knowledge, Mr. Trump will not cut Social Security, Medicare, and Medicaid?”

        Price testified: “As I say, I have no reason to believe that that position has changed.”

        With regard to out-of-pocket maximums, it’s true that the ACA caps them. But there’s a formula to determine the cap, and it’s calling for another increase in 2017.

        In response to your suggestion about leaving the ACA alone and structuring an AHIA instead, I partly agree. But, overall, the ACA has essentially been nothing more than a temporary Band-Aid for our ailing health care system. Comically, we’re just rearranging the deck chairs on the Titanic, and despite a decrease in the rate of premium increases, an increase is nonetheless an increase–no matter how you look at it. Perhaps the most systematic and equitable approach to expanding coverage and access is through comprehensive national health care reform.

        Liked by 1 person

  8. The people coming into power are severely out of touch with the lives of others -& have no interest in or respect for lives different from their own. They just don’t care about the larger community of humanity. For those not already uber-wealthy, dire times are coming.


  9. There seems to be no easy answers. There are many like my family who try to live this American dream and run the gauntlet of small business ownership, with all the attendant stress that involves. I would not have believed if I was told our premiums would go from $168 per month in 2012 to $1,091 per month for 2017. Deductible went from $8K per year to $14,900 per year for the family. We are healthy and rarely make doctor visits. This has been a slap in the face and has shaken our belief in the American way. A blatant redistribution thinly veiled.


    1. I agree that the ACA needs reform, though I’m not sure what your situation is, your income, what state you live in. My experience so far: We were able to afford a gold plan the first year for about $400. The next plan we opted for was silver after the gold plan was canceled. That was somewhere around $350. Because I didn’t like the hospital network associated with that plan, we’re switching to a gold plan for this year, a little over $600, but our deductible is $1000. We received a small raise the first year, but since then our income hasn’t altered.

      I agree there needs to be reforms to make health insurance more affordable. Many people are falling into the hole of earning too much to receive tax credits.

      That said, repealing the ACA without a replacement plan would create a tax *increase* for 60% of Americans, those earning under $67,000 a year, while being a tax cut for the very top. People earning over $430,000 a year would save $25,000. Those earning over $1.9 million a year would pay $165,000 less in taxes. In that way, I suppose it is a blatant redistribution.


      1. I value your input which reinforced my feeling that there are no easy answers. It is this vulnerable population which falls in-between your values that grows dispirited and demoralized by a system which seems to punish industriousness. Thanks for your perspective. Candid and respectful debate is refreshing and constructive.

        Liked by 1 person

      2. Thank you for engaging with me! I absolutely want to know what other people are experiencing. I’m an advocate of solutions-based policy, meaning I want to work backwards from the end-result goals. Both sides seems to have procedures and ideologies they want to champion before solutions. As a nation we’re not doing a good job coming to a consensus on what problems we’d need to tackle and often end up talking past each other because we’re discussing fundamentally different things surrounding the same subject.

        For example, when I think of healthcare policy, I think of my husband who grew up working poor, despite having both his parents working full time jobs (with periods of unemployment due to layoffs). In addition to poor nutrition, he missed out on some basic care, including dental. His first tooth was pulled in his teens. Now, in his mid-thirties, most of his teeth are in horrible shape. We need to put thousands into his mouth because his parents were unable to afford basic care in his childhood. That said, he’s the first to admit that his parents weren’t great with money. Were they to have scrimped and saved, skipped out on some material things, he and his brothers would be better off. I just don’t like knowing that there’s a system in which parental irresponsibility (and economic status) can be so easily passed onto the next generation.

        Policy to address his situation is very different than policy that deals with struggling middle class families, whose issues are no less important. I think one of the failings of the ACA was not realizing how indebted and leveraged people are in the middle class. Standard of living tends to increase with income, ergo for people making just above the income for subsidies ($87,000 for a two parent household + child), increased health insurance spending can really disrupt their budget. And nationwide, even statewide, policies don’t do a good job of taking into account variable cost of living in different regions.

        Yep, no easy answers. I agree.


  10. My sympathy is with you. From your perspective, all is not rosy for people like you though other Americans think otherwise. Please continue with the struggle to address this issue and make a difference.


  11. It would seem as though there is nothing to fear, as I feel private insurance is cheaper and better. ACA should have never existed to begin with as it simply is something bestowed on the people who are encouraged to pursuit happiness. I have a hard time understanding why taking away the choice of either having or not having insurance by penalizing those who don’t have insurance is better and to repeal or replace such a plan is terrifying. Moving forward with your dreams and happiness isn’t a choice made by the government, but a choice by you. You are achieving your dream through your hard work, and great job! I love my choice to have whatever insurance I choose.


    1. Hi! Thank you for your service!

      For so many Americans, having or not having health insurance hasn’t been a choice up until this moment. For the 20 million plus Americans who have received insurance through the ACA, purchasing insurance without the subsidies was an impossibility. The choice to have or not have insurance was based on income, not on desire.

      You mention hard work and dreams, however neither lead to financial success in farming. I’ve had one full day off in the past three years. I took my last vacation in 2010. If a combination of hard work and dreaming led to success, I’d be a millionaire. Unfortunately, long hours, blood and sweat do not equal success. When I think of health insurance, I’m often thinking of my future. Of my parents. They milked cows twice a day, every day, for twenty-five years. After selling their herd in 1999, my mother went to work for the Farm Service Agency, moving later to secretarial work at a state hospital, to maintain healthcare coverage. This care has been vital to them after years of hard work. My father had to have a valve replaced in his heart in 2002. He has bad knees, congestive heart failure, stage three kidney failure. My mother, in much better shape, has arthritis in both her knees and hips from squatting down to milk our cows. Their dream, to have a farm, to have children, was realized, but it would all be for naught if they didn’t have insurance to pay their medical bills.

      In this way, a functioning, affordable health care system is a core value of the American Dream, protecting both life and property.

      I know that the insurance mandate, forcing people to either buy insurance or pay a penalty, seems unfair, however I’m going to quote John Locke on this one:

      “Sec. 129. The first power, viz. of doing whatsoever he thought for the preservation of himself, and the rest of mankind, he gives up to be regulated by laws made by the society, so far forth as the preservation of himself, and the rest of that society shall require; which laws of the society in many things confine the liberty he had by the law of nature.”

      Meaning, that when we, as a people, join a society, we’re ceding some freedoms to the government (our duty to it), to make a society that benefits all. In this way, our government is one giant insurance plan, providing protections to its people through mutual sacrifice of some liberties. The ACA came into being because the existing system was not serving to preserve the financial and physical health of society. I met parents who, despite having insurance through an employer, went into bankruptcy because their insurer wouldn’t cover cancer treatments for their twin daughters. My great-grandfather had to leave his farm and move into town when his spleen was ruptured after he was attacked by a bull. My in-laws are still suffering from hospital bills they accrued when my brother-in-law got sick in 4th grade–he’s 30 now. Accidents happen. Illnesses happen. Should people lose their property, their wealth, to save their lives?

      Again, I know the mandate seems unfair, but it was a way to make the system work. Insurance plans function only if people pay more than they take out. The Supreme Court ruled that the penalty was a tax, which is how it functions. People who opt out of the mandate pay in, thus contributing to society. Depending on which replacement plan takes the place of the ACA, you’re going to see a continuation of some version of the mandate. One of the solutions currently under debate is making health insurance opt-out rather than opt-in, meaning that even people who don’t choose a plan will be enrolled in one.


      1. Wow, I am new to WordPress and am using from my phone so please pardon any grammatical errors. Thank you for your reply, I really didn’t expect it, so obviously you are passionate about this situation. No doubt through your words and situation you are faced with.
        After reading your reply, I was concerned with some statements and this lead me to go and do some pricing as well as take my childhood memories and experiences into consideration.
        After inputting all of my information into the I would have to pay 610 dollars per month for me and my 3 children. Yes I am a single dad and yes that is a remarkably expensive coverage for Healthcare. However, when I compared to private plans that are written by top insurers, I see the average plan I would pay would be between 230 and 250 per month. I have to also mention, the penalty for not having insurance is, “$695 per adult and $347.50 per child (up to $2,085 for a family), or it’s 2.5% of your household income above the tax return filing threshold for your filing status – whichever is greater.”
        I mention prices because it seems to me the choice is easy, pay the lesser amount and have a better insurance.
        Thank you for your quote of the Locke, however I will make mention that Reagan warned against socialized medicine and stated that American freedoms will go soon after. Remember that while our country is still in its infancy stage, we have been able to go much further in the formation and governing due to many freedoms taken for granted.
        The penalty for not having insurance is a form of redistribution of wealth. The American government is not a business nor does it generate income, so the money to fund such a large government insurance is completely and utterly against what we believe in as Americans. Socialism should stop with libraries, thank goodness for books a million.
        Sorry, was getting off topic. I suppose I just have a hard time understanding why it’s the government’s problem when I get sick, unless of course it’s the government I work for, or the country I fight for. Even at that point, I still choose what Dr I want to see.


      2. First of all, props to you for raising three kids on your own. My brother has three kids, my husband is the oldest of three boys, and my best friends growing up were a family of three boys.

        I looked into the price of insurance plans for our area. We currently pay a little over $600 for a high-quality plan (gold). We’ve gotten silver plans in previous years, but I’ve been having tendon issues in my hands, wrists, and arms, which might lead to surgery this year, so we decided to opt for a better plan.

        Our plan has low co-pays in network (25 dollar office visits, 60 dollar specialist, 300 dollar emergency room), $1000 deductible per person, and $7000 out-of-pocket maximum per person. This cost of this plan without subsidies is a little over $1200. The lowest plan I was able to find for our area was $453 without subsidies, close to a catastrophic plan. The deductible was the same as our out-of-pocket maximum. While it’s cheaper than our marketplace plan, the coverage is nowhere near as valuable. Geisinger, Blue Cross, and Capital Blue are available in our area.

        I understand what you’re saying about the redistribution of wealth. There’s a little joke in our household: In rural Pennsylvania, we’re liberals. In California, we’re moderate Republicans. I don’t consider myself to be an advocate of socialism, but so much of our lives are already dictated by government subsidies. The food on the grocery store shelf is produced for a low price because the government provides low-income loans to farmers, manages crop insurance programs, subsidizes the construction of more efficient feed processing. I won’t even get into the price of milk, which is set by a government-business partnership. The majority of dairies have to sell to co-ops and cannot ask a different price for their milk. The price is set, period. Right now, most US dairies are spending more to produce a hundred-weight of milk than they are making on said milk and can’t do anything about it until the price increases.

        (That was my little farm rant)

        Business are subsidized in the form of tax breaks, creating jobs. Hospitals are subsidized. Corporate-funded infrastructure projects (like fiber optic cable) is subsidized.

        Whether the best system of governance is one in which the government effects the job market, food production, infrastructure through tax breaks and subsidies is up for debate. However, if we’re going to provide money to farmers for the affordable production of food, I don’t see why we shouldn’t be providing money to citizens to help them live healthy lives. I understand why it might not seem like the government’s concern, but a healthy population is a productive population and financially stable families (not burdened by illness) are less likely to need assistance.

        As I said, I’m totally open for debating these things. There seems to be a lot of ideological tension surrounding freedom right now. It seems to fall into two categories: Freedom to and freedom from. Freedom to own the guns of our choosing, freedom to have free speech (okay, the entire Bill of Rights). Freedom from is an expanding conversation. Freedom from debt, freedom from illness, freedom from hunger. There’s tension between two concepts: those who want safety through our government and those who was safety from our government, whether equality is more important or freedom is more important.

        Again, these are just things that occupy my mind while I’m milking cows.


  12. Thank you for painting a very personal and representative picture of your life and experience. I also appreciate the very open debate you opened up in the responses. Good luck to you and I’ll be following your story.

    Liked by 1 person

    1. Thanks! I’m aware I don’t have all the answers and want to have open dialogue about issues. Listening to, and considering, someone else’s opinion never hurt anyone. I think we come to better solutions, both in life and in public policy, if we can take in a variety of different opinions. Those who only hear their own opinions echoed back tend to radicalize. Those who engage with other views moderate. I truly want to know the realities in which other people are living. It enriches my understanding of issues facing this country, provides me with solutions alternative to those I can dream up on my own.

      Liked by 1 person

  13. The theory of Affordable Care Act was correct… healthcare for everyone. The actuality of it is a mess. It does need repealed. Its only driven costs of insurance skyrocketing while coverage has actually plummeted. People are paying tons more and getting tons less. Hospitals, doctors’ offices etc nationwide are making severe cuts to lower their overhead because reimbursement is so minimal. Fulltime jobs are being cut because employers can no longer afford the sky rocketing premiums. Does something need to be done? Yes. Is the answer ACA/Obamacare… absolutely not. It will bankrupt our country.


    1. Hi! Thanks so much for responding. I was wondering if you could tell me what source you’re using for your data? It didn’t sound right compared to articles I’ve been reading, but I’m not great at keeping exact statistics in my head at all times, so I did some research during lunch. Here’s what I found out:

      Insurance premiums have not skyrocketed since the enactment of the ACA. Rather, they have risen at a similar, if not slower rate than before. In 2016, employer-based insurance plans rose 3%, while inflation rose 2.5% In other words, employer insurance premiums rose .5% above inflation.

      Source: CBO release chart showing steady rise in health insurance premiums since 2001. No sharp increase due to the ACA.

      Source: Kaiser Family Foundation showing that the percentage premium increases were smaller between 2011 and 2016 than in previous years.

      Now, the Kaiser Family Foundation article notes that deductibles have risen at a much sharper rate in recent years. If this is what you mean by people getting tons less and paying tons more, I will concede. However, I don’t believe the quality of health insurance is dependent on the deductibles alone. The ACA functioned as a consumer-protection bill, ensuring that health insurance plans met a certain level of quality to be legal. This includes protecting people with preexisting conditions, mental health care needs, clarified essential benefits, and limited out-of-pocket maximums.

      To this point, a preliminary 2016 report about the affect of the ACA on the individual market shows that premiums paid by individuals are both lower than anticipated by the Brooking’s Institute and lower than projected plans without the ACA.


      Additionally, the article notes that, “While many stories of pronounced increases are simply the natural result of a law that works differently in every region and for people of different health statuses, it appears to be conventional wisdom that the ACA increased premiums in the individual, non-group insurance market, if only because it increased the quality and robustness of coverage.”

      In other words, the costs are higher because the coverage is better.

      To your next point regarding full-time jobs being cut, from this link,, you’ll find a chart demonstrating full time employment data. Click on the 10 Y (ten year) tab and you’ll see that we’ve been on a steady uptick in full time employment since 2010. No hitches demonstrated as a result of the enactment of the ACA.

      Also, according to this article about impacts of the ACA on employment, except for minimum wage employees, employers tend to pass on the cost of increased health insurance premiums to their employees rather than covering it themselves.

      Also, your focus seems to be on full-time jobs, however the ACA has allowed people with part-time jobs to get health insurance. This is valuable for working mothers, students working their way through college, retail employees who work two part-time jobs to make ends meet. When my husband worked in retail management, before the ACA was passed, most of his employees worked two or three part-time jobs, none of which offered health insurance.

      It’s been hard for me to find concrete data regarding how the ACA has affected doctors and hospitals. In part, this is because outcomes are different for states that took or refused the medicaid expansion, so there’s no good national data. I know the medicaid expansion has been vital to the health of rural hospitals in states that accepted it. States that accepted the medicaid expansion received reimbursements in line with medicare, which paid much more. Those who didn’t take the expansion missed out on those benefits.


      I did find a Forbes article talking about the ACA’s impact on private doctors and their bottom lines. Basically, seeing more patients with medicaid has affected their bottom line. It didn’t talk about severe cuts. Rather, that private doctors may be choosing to move to hospitals rather than make less profit.

      As I said, I’d love to see your sources. What replacement plans to you support?


  14. i have 2 kids in college and was just scraping by. since the ACA was enacted the premiums havent risen too much. but the cost of medication has increased from 175/every 3 months, to over 900 every three months which is what i was paying for their books. i cant work anymore because i cant afford my meds.

    so the ACA saves money by making my medication unaffordable and leading me towards an earlier death.

    thank you…


    1. Hi! I’m terribly sorry to hear about your situation. Are/ Were you getting your health insurance off the exchange, through an employer, or through a government program? Has your insurance plan changed, has the percentage paid for your medications decreased or the cost of your medications increased? I hope you’ll give your congressman and senators a call. If we’re moving forward with repeal and replace, those who are having problems with the current system need to have those problems heard so they can be avoided in future bills.


  15. I always find it strange when people don’t fight for healthcare. In my experience, in India healthcare is the most expensive. For operations people have to spend about two to three months salary and this never includes the post operation expenses. Having an insurance was never a perfect solution either as there are too many technicalities which left the owner in the false pretense of safety.

    Healthcare is the basic need, synonymous with food clothing and shelter. It should be given.

    I hope something good comes out of scraping the ACA


  16. I have to agree somewhat with rhapsodise above. While there seems to be this panic going around not sure I agree that it’s warranted. Yes, Trump being the political buffoon that he is I’m sure he’d love to go to the wall and just pull the plug this afternoon without any thought to the ramifications. But here’s the thing, we have a Constitution.. and according to the latest polls only 38% believe this guy is doing anything right. Forgetting the polls.. he still won with a minority of popular votes.. and those matter in Congress, republican majority or not. Now we know our Dear Leader could care less about political suicide but the rest of his party might. You seem to have a good grasp of Obamacare.. you might want to feed that to your local elected officials.


    1. I had the opportunity to attend a meeting with Senator Casey at the beginning of January in which I was able to advocate for affordable healthcare for farmers and employees of small businesses. Both my other senator and congressman have been much less forthcoming. My congressman’s office couldn’t tell me which replacement plan he supported. (I was told I’d be sent a letter detailing his choice. Over a month later, it hasn’t arrived). I received no response from my other senator when I sent both this post and a letter to his office, though I got a form letter from a phone call I made later.

      One of my largest issues with the replacement plans that are being floated is that they seem to hurt older, sicker, poorer Americans–those who are already disadvantaged in the system. Recently, I listened to an interview with Avik Roy on The Ezra Klein Show. It’s worth a listen. Among other things, he talked about Transcending Obamacare, his proposed replacement plan. I find lots of persuasive arguments in conservative ideology, however they all seem to focus on rational actors (how many of us are rational when dealing with a healthcare crisis) who are able to manage comparative pricing and paperwork in a healthcare system (and then consider that only 33% of Americans even file their own taxes). It’s more complicated with the geographical complexity of our country, allowing for far less possible healthcare competition in rural areas due to lack of facilities and people with lower incomes will still have less opportunity to receive quality care.


      1. Well……. I’ve only known you for two replies in here thus far.. other than reading a couple posts. When a person is more than just presenting “angst” or a chip-on-the-shoulder passion… and demonstrates an ability not only to analyze but to “argue” a position with a measure of sense and coherent use of the King’s English.. that’s a big plus to me for elected office. But, hey… I thought Trump would lose. 🙂


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