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Rural America target of federal health care discussion

President Donald Trump gathers with Vice President Mike Pence, right, and congressional Republicans in the Rose Garden of the White House after the House approved the American Health Care Act Thursday, May 4, 2017. Carlos Barria / Reuters1 / 2
President Roger Johnson of the National Farmers Union speaks at southwest Minnesota's Farmfest in August 2016. After the U.S. House passed a health insurance overhaul bill Thursday, May 4, 2017, he said it would hurt farmers. Don Davis / Forum News Service2 / 2

ST. PAUL—The battleground for new federal health insurance legislation may be in the same place as last year's presidential election was decided: rural America.

Democrats are telling rural Donald Trump voters that they do better under current law championed by then-President Barack Obama.

An example comes from the Democrat-leaning National Farmers Union and its president, a former North Dakota agriculture commissioner.

Farmers Union President Roger Johnson said after the House approved new health care laws Thursday, May 5, that it especially hurts rural residents. He said it is worse than the first Republican-written bill that failed earlier this spring.

"Many of the issues from the original legislation persist; the bill would still cap Medicaid (free health care for the poor), disproportionately affecting rural Americans who enroll in Medicaid at higher rates, and whose hospitals rely more on the program than their urban counterparts," Johnson said. "The bill would also base subsidies on a person's age, adversely affecting younger farmers, while dramatically easing restrictions on what companies can charge older farmers."

Rural residents, especially farmers, tend to rely more on buying their own individual health insurance policies because they often do not work for employers who provide insurance. Those individual policies, as well as public medical coverage such as Medicaid, are more affected than employer-supplied insurance by current federal law known as Obamacare and the GOP House's proposed American Health Care Act.

The House passed its replacement for Obamacare 217-213 Thursday with no Democratic support. It now goes to a Senate that may demand a different bill.

Trump has called Obamacare a "disaster" and congressional Republicans have long targeted the 2010 law, formally known as the Affordable Care Act, calling it government overreach.

Republicans have found overturning Obamacare politically perilous, partly because of voter fears, loudly expressed at constituents' town-hall meetings, that many people would lose their health insurance as a result.

In northwestern Wisconsin, for instance, Joyce Luedke saw a difference between many in her state and U.S. Rep. Sean Duffy, a Republican who represents her.

"I told Congressman Duffy we the taxpayers cover his family of 10 with quality health insurance," Luedke said. "Has he ever acknowledged our contribution to him and his family?"

Duffy spoke about the Republican bill in glowing terms when interviewed on Fox News Channel: "So this is a huge step in moving forward for the American people and getting a sane health care system that will look out for the American people and families instead of bureaucrats here in Washington."

Some Republicans, like U.S. Rep.Tom Emmer from just north of the Twin Cities, said the GOP bill is not perfect, but giving states more authority means residents will benefit.

U.S. Rep. Kevin Cramer, R-N.D., said people in his state who complain about losing access to policies and facing "increasing premiums and skyrocketing deductibles" would get relief from the House-passed bill.

In rural areas that do not favor federal control, lawmakers say the Republican plan is just what the voters wanted.

"I do not believe the federal government should be the decision-maker on health care," said U.S. Rep. Kristi Noem, R-S.D.

Top Republicans use Iowa as an example of Obamacare problems, as Minnesota-based Medica is dropping its individual health insurance in most counties. The same thing already happened in Minnesota, with many people warning that much of the state may have no individual policies available next year.

While Republicans blame Obamacare for health insurance woes, Democrats tell rural Americans that the current law is better for them than the Republican alternative.

The Minnesota Health Department, part of Democratic Gov. Mark Dayton's administration, reported shortly before the House vote that the number of Minnesotans without health insurance dropped more sharply in greater Minnesota than in urban areas since 2011. Obamacare was credited.

"It is encouraging to know that in recent years Minnesota made significant progress on a key health equity issue by eliminating insurance disparities between rural and urban residents," Health Commissioner Dr. Ed Ehlinger said. "However, it is also clear that this important gain could be in jeopardy. This study shows that any repeal of the ACA (Obamacare) without a replacement ensuring similar rural coverage levels would disproportionately hurt rural Minnesotans."

The Health Department claims that repealing current federal law could cost Minnesota $2.5 billion and affect 1.1 million Minnesotans.

Minnesota lawmakers and the governor are taking actions to open the market for more insurance companies next year.

Unlike many other Upper Midwest states, Minnesota provides a state-run health insurance sales site, MNsure. Most states rely on a federal sales service.

MNsure's chief executive officer said Minnesotans should not worry about this year's coverage, regardless of what Congress does.

"It is important to know that no matter what happens at the federal level your coverage this year will not change, so long as you continue to pay your premiums," Allison O'Toole said.

Don Davis
Don Davis has been the Forum Communications Minnesota Capitol Bureau chief since 2001, covering state government and politics for two dozen newspapers in the state. Don also blogs at Capital Chatter on Areavoices.
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