Modoc County, in the northeastern corner of California, is roughly the size of Connecticut. It鈥檚 so sparsely populated, the entire county has just one stoplight. The nearest Walmart is more than an hour鈥檚 drive, across the Oregon border. Same with hospitals that deliver babies.
Greta Elliott runs a tiny health听听in Canby, on the edge of the national forest. 鈥淩ural鈥� doesn鈥檛 begin to describe the area, she听says. This is 鈥渢he frontier.鈥�
鈥淭here are more cows in Modoc than there are people,鈥� Elliott said.
There鈥檚 a frontier mentality, too. People take care of each other, and they take care of themselves. They don鈥檛 like being told what to do. Being forced to buy insurance made 鈥淥bamacare鈥� a dirty word.
Even clinic administrator Elliott, who doesn鈥檛 have job-based coverage, decided against buying it for herself.
鈥淚t鈥檚 too expensive,鈥� she said. 鈥淚 choose to put my money back into paying the bills of the whole family.鈥�
But now a听听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.
鈥淲e thought, 鈥榃hoa! That is really bold,鈥欌�� 听said Dean Germano, CEO of the听. 听鈥淚 was surprised.鈥�
Overall, the Affordable Care Act 鈥� known informally as Obamacare 鈥� helped 25,000 people in far Northern California buy plans through the state marketplace,听. But the law helped three times as many people 鈥撎�75,000 鈥撎齟nroll in Medi-Cal, the state鈥檚 Medicaid program that provides free health coverage for low-income residents.
鈥淭he data shows it鈥檚 the rural communities that have greatly benefited from the Medicaid expansion. That鈥檚 the irony,鈥� Germano said. 鈥淭hese are places that voted much more heavily for Donald Trump.鈥�
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,听, asking him to vote against听the initial GOP repeal and replace bill, because it would hurt local people.
鈥淲e have an obligation to say something,鈥� said Supervisor David Kehoe. 鈥淎nd if it may be mildly offensive from a political standpoint for some, well, we鈥檙e not going to be intimidated by politics.鈥�
LaMalfa still voted in favor of dismantling Obamacare.
He didn鈥檛 return calls and emails for this story, but, in May,听听that skyrocketing premiums were the main driver behind听his vote.
鈥淯nfortunately, the reality is that too many young and healthy individuals are deciding they鈥檇 rather pay the penalty than sign up for care, citing financial barriers and lack of choice,鈥� he said in a statement. 鈥淎 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.鈥�
When听clinic representatives听met with LaMalfa鈥檚听staffers, they were told the congressman鈥檚 office was flooded with calls from middle-income consumers like this.
But poor folks on Medi-Cal didn鈥檛 call to say how much they appreciate the听program. In fact, clinics struggled getting people to sign up for Medi-Cal, at first.
鈥淭hey feel like it鈥檚 a handout and they鈥檙e too proud, they don鈥檛 want to,鈥� said Carol Morris, an enrollment counselor for the听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听and may not realize they鈥檙e actually covered by a government program.
鈥淚t feels like it鈥檚 more of an insurance,鈥� Morris said. 鈥淚t鈥檚 like a laminated, wallet-sized card that鈥檚 got your numbers on it. It just looks exactly like an insurance card.鈥�
One patient at the Mountain Valleys clinic in Beiber, Kay Roope, 64, knew she had Medi-Cal, and she liked it.
鈥淚t did me good,鈥� she said.
Now she has a subsidized commercial plan through Covered California, with modest premiums and copays, and she likes that, too.
鈥淚t鈥檚 OK. 鈥楥ause I鈥檓 at the doctor鈥檚 at least once a month,鈥� she said.
But when asked what she thinks of Obamacare overall, she says she doesn鈥檛 like it.
鈥淏ecause of Obama himself,鈥� she said with a laugh. 鈥淚 rest my case.鈥�
The confusion and the contradictions are common among patients, explained Morris, the enrollment counselor.
鈥淧eople just don鈥檛 understand the different names,鈥� she said. 鈥淏ut, of course, it鈥檚 the same thing.鈥�
Morris has seen the difference Obamacare has made for people in the region. She鈥檚 seen patients get treatment for diabetes and breast cancer, or get knee surgery that they otherwise wouldn鈥檛 have gotten.
Those patients won鈥檛 fight for Obamacare, Morris said, so that鈥檚 why the clinics have to.
This story is part of a partnership that includes听,听听and Kaiser Health News.