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Posted: 2017-04-01 00:10:18

Posted April 01, 2017 11:10:18

Under the crisp midday sun in the hills of rural West Virginia, the Myers family pile out of their tired, red pick-up truck in the car park of the Cabin Creek Health Centre.

"A couple of them had the flu and this one had an allergic reaction and we can't figure out what it is exactly," said Ardith Myers as she gestured to her 15-year-old daughter, Alexis, who held her hand over her face.

"So I thought I'd just bring them all, just to get them all checked you know, just to make sure," she added, flanked by her four daughters, aged three to 17.

Before the Affordable Care Act — known as Obamacare — was passed seven years ago, a trip to the doctor like this would have been an unaffordable luxury for Ms Myers.

"My husband does work but we can't afford medical bills without it, so it's helpful," she said.

West Virginia is one of the poorest states in America.

Things were quite dire for many in the Mountain State before Obamacare came in.

"I had patients who would come in and say, 'I can either pay for my medication or buy my kids' shoes'," Cabin Creek physician Dr Mitch Jacques said.

He estimated now one-in-five of his patients was covered under the Affordable Care Act. Statewide, it's 200,000 — nationally, 15 million. Despite the help Obamacare provided, West Virginians voted overwhelmingly for Donald Trump in the presidential election, despite his promise to abolish it.

Dr Jacques and his colleagues breathed a sigh of relief last week when Republicans abandoned their plan to repeal and replace the Act because of party infighting.

'It is exploding right now'

While Republican House Speaker Paul Ryan said "Obamacare is the law of the land for now", US health care is entering an uncertain era.

Obamacare did two key things — it allowed states to expand insurance coverage for the poorest Americans under what was called "Medicaid", and it created a marketplace for private insurers to provide affordable plans to working people who do not get health care from their employers.

Since its creation in 1965 and expansion under former president Barack Obama, Medicaid has become entrenched in American society. 74 million people rely on it for coverage. Some Republican members of Congress were not prepared to vote for their party's Obamacare replacement legislation because of fears Medicaid would be rolled back.

While healthcare reform is off the table for now, Mr Trump has hinted at what he plans to do.

"I've been saying for the last year-and-a-half that the best thing we can do, politically speaking, is let Obamacare explode," he said last week after Republicans' aborted their vote in the House of Representatives.

"It is exploding right now."

'Hopefully ... that's one thing he doesn't mess up'

Experts say there are also things the Trump administration can do to undermine Obamacare — including Medicaid — and allow it to fail.

"The Trump administration has a lot of flexibility under the law that creates the Affordable Care Act to either make or break the law for people," said Professor Sara Rosenbaum, a health policy expert at George Washington University.

"The executive branch can either operate the program to be as embracing of the population as it can possibly be, or it can choose to operate a program in a way that makes it very hard to get benefits, keep benefits, [and] come back in if you lose benefits.

"We just don't know really what the administration is going to do."

Interestingly, Mr Trump's failure in Washington to repeal and replace Obamacare has been a win for many of his supporters in places like West Virginia where he remains popular.

"I know a lot of people don't seem to like him, but he seems to be doing more to help people," Ms Myers said.

"So hopefully with the insurance, that's one thing he doesn't mess up."

Topics: donald-trump, health, world-politics, united-states

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