Modoc County, in the northeastern corner of California, is roughly the size of Connecticut. Its so sparsely populated, the entire county has just one stoplight. The nearest Walmart is more than an hours drive, across the Oregon border. Same with hospitals that deliver babies.
Greta Elliott runs a tiny health泭泭in Canby, on the edge of the national forest. Rural doesnt begin to describe the area, she泭says. This is the frontier.
There are more cows in Modoc than there are people, Elliott said.
Theres a frontier mentality, too. People take care of each other, and they take care of themselves. They dont like being told what to do. Being forced to buy insurance made “Obamacare” a dirty word.
Even clinic administrator Elliott, who doesn’t have job-based coverage, decided against buying it for herself.
Its too expensive, she said. I choose to put my money back into paying the bills of the whole family.
But now a泭泭of clinics from across the northeastern corner of the state is lobbying local officials to take an unpopular position in this conservative land: Defend Obamacare.
And the right-leaning Shasta County Board of Supervisors took them up on it.
We thought, Whoa! That is really bold, 泭said Dean Germano, CEO of the泭. 泭I was surprised.
Overall, the Affordable Care Act — known informally as Obamacare — helped 25,000 people in far Northern California buy plans through the state marketplace,泭. But the law helped three times as many people 泭75,000 泭enroll in Medi-Cal, the states Medicaid program that provides free health coverage for low-income residents.
The data shows its the rural communities that have greatly benefited from the Medicaid expansion. Thats the irony, Germano said. These are places that voted much more heavily for Donald Trump.
In Modoc and Lassen counties, 70 percent of people voted for Trump in the November election. In neighboring Shasta County, Trump won 64 percent of the vote.
Given the stakes, however, the Shasta County Board of Supervisors sent a letter in the spring to the local Republican congressman,泭, asking him to vote against泭the initial GOP repeal and replace bill, because it would hurt local people.
We have an obligation to say something, said Supervisor David Kehoe. And if it may be mildly offensive from a political standpoint for some, well, were not going to be intimidated by politics.
LaMalfa still voted in favor of dismantling Obamacare.
He didnt return calls and emails for this story, but, in May,泭泭that skyrocketing premiums were the main driver behind泭his vote.
Unfortunately, the reality is that too many young and healthy individuals are deciding theyd rather pay the penalty than sign up for care, citing financial barriers and lack of choice, he said in a statement. A 28-year-old making $45,000 a year with no major health concerns is not going to pay upwards of $400 a month for a plan that does not even work for them.
When泭clinic representatives泭met with LaMalfas泭staffers, they were told the congressmans office was flooded with calls from middle-income consumers like this.
But poor folks on Medi-Cal didnt call to say how much they appreciate the泭program. In fact, clinics struggled getting people to sign up for Medi-Cal, at first.
They feel like its a handout and theyre too proud, they dont want to, said Carol Morris, an enrollment counselor for the泭health clinics in Shasta County.
One way clinic workers get around the stigma is to avoid calling it Medi-Cal. Instead, they promote the name of the insurer that manages the Medi-Cal contract in that region. People get a card for泭and may not realize theyre actually covered by a government program.
It feels like its more of an insurance, Morris said. Its like a laminated, wallet-sized card thats got your numbers on it. It just looks exactly like an insurance card.
One patient at the Mountain Valleys clinic in Beiber, Kay Roope, 64, knew she had Medi-Cal, and she liked it.
It did me good, she said.
Now she has a subsidized commercial plan through Covered California, with modest premiums and copays, and she likes that, too.
Its OK. Cause Im at the doctors at least once a month, she said.
But when asked what she thinks of Obamacare overall, she says she doesnt like it.
Because of Obama himself, she said with a laugh. I rest my case.
The confusion and the contradictions are common among patients, explained Morris, the enrollment counselor.
People just dont understand the different names, she said. But, of course, its the same thing.
Morris has seen the difference Obamacare has made for people in the region. Shes seen patients get treatment for diabetes and breast cancer, or get knee surgery that they otherwise wouldnt have gotten.
Those patients wont fight for Obamacare, Morris said, so thats why the clinics have to.
This story is part of a partnership that includes泭,泭泭and Kaiser Health News.
