Aaron Albaugh peered out from under the brim of his cowboy hat, surveying the acres of hayfields in front of him. The fourth-generation聽聽has raised about 450 cattle this year, in this remote corner of Lassen County, Calif.
His closest neighbor lives a half-mile away. 鈥淎nd that鈥檚 my brother,鈥� Albaugh said.
鈥淚f I want to go see a movie, it鈥檚 70 miles, round-trip,鈥� he added. 鈥淚f I want to go bowling, that鈥檚 100 miles, round-trip.鈥�
Living a half-day鈥檚 drive from civilization, you learn to do without, he explained. If your refrigerator breaks, you put your food on ice until the weekend when you can go buy a new one. With health care, it鈥檚 the same thing.
鈥淧ut a Band-Aid on it,鈥� Albaugh said. 鈥淚 was raised: 鈥榊ou don鈥檛 need to cry鈥� and 鈥楽uck it up, buttercup.鈥� That鈥檚 the way I still live, and I try to treat my kids the same way.鈥�
For聽people聽who were聽already used to doing without health coverage, it was quite聽a culture shock when the Affordable Care Act came along and they were told they had to buy it. Residents complained that the premiums and deductibles were too high 鈥� and聽with only two insurers selling plans in their area, there wasn鈥檛 enough competition to bring down prices.
Many in this Republican corner of California are looking to the GOP聽majority in Congress to bring some relief. But聽for most of them,聽prices would jump even more under the main proposals the party has served up so far, and fewer services would be covered, according to analyses by the Kaiser Family Foundation. (Kaiser Health News, which produces California Healthline, is an聽editorially independent program of the foundation.)
鈥淏eing told you have to have insurance you can鈥檛 afford, and then聽迟丑补迟听doesn鈥檛 cover what you need? You are stuck,鈥� said Modoc County resident Althia Cline, who decided to forgo Obamacare coverage 鈥� and a surgery she needs to help with her asthma 鈥� when she couldn鈥檛 find a health plan that her doctors accepted.
Just like the movie theater and the bowling alley, most medical specialists are miles away. In Modoc County, there鈥檚 no hospital or birthing center where a woman can have a baby.聽Tessa Anklin, who lives in Canby, Calif., gave birth to her son and daughter over the border in Oregon, an hour and a half聽from home.
Anklin makes about $33,000 a year as a dental receptionist. Her husband does seasonal work baling hay and herding cattle at local ranches. While their kids are covered by Medi-Cal, neither parent gets health insurance through work, and before the Affordable Care Act passed, Anklin and her husband did without coverage for a while.
Tessa Anklin says Covered California health plans are too expensive for her family. (April Dembosky/KQED)
Two years ago, they bought a plan through Covered California. Their monthly premium was just $2 a month after the ACA subsidy, but their annual deductible was $10,000.
鈥淲e paid for all of our medical services and our prescriptions,鈥� she said. 鈥淲e had no help until we reached the $10,000 deductible. So really, we had nothing.鈥�
Then, last year, their monthly premium jumped to $600. Anklin said she鈥檚 not sure what happened. It鈥檚 possible a technical glitch caused聽them to lose their subsidy. All聽she knew was 迟丑补迟听the plan was the same,聽their household income was the same,聽and they still faced the same hour-and-a-half drive to see doctors they almost never needed.
Anklin thought of all the other ways聽they could spend that money.
鈥淚t makes the car payment. Almost your mortgage payment. Groceries for at least four months,鈥� she said. 鈥淭hat鈥檚 a big difference, when you think about how little you actually use the health coverage.鈥�
That鈥檚 the reason聽they decided to cancel聽their health plan this year and go without insurance. But they鈥檒l still have to pay a penalty when the next tax season comes around.
鈥淚t basically penalizes us one way or the other because we can鈥檛 afford the coverage,鈥� she said. 鈥淪o, that鈥檚 kind of difficult 鈥� to be that middle-class person.鈥�
Anklin said she鈥檇 be happy to see Republicans get rid of Obamacare.
鈥淭o me, it鈥檚 no good, if you have to force people to pay yet another something out of their paycheck,鈥� she said, 鈥渨hen they鈥檙e already trying to survive with what they have.鈥�
But the Republican 鈥渞epeal and replace鈥� plan wouldn鈥檛 make things much better for Anklin and her neighbors. Average premiums in California would double under the聽聽 U.S. Senate plan, according to a recent 聽from the Kaiser Family Foundation. Anklin could end up聽paying roughly $2,000聽more聽per year for the cheapest individual plan than under Obamacare,聽according to Kaiser鈥檚聽.
That鈥檚 not the kind of fix聽she had in mind.
鈥淚鈥檇 love that insurance could be more affordable for families that need it, for families that work hard for it,鈥� Anklin said.
With聽Republican聽health care plans聽in flux, Democrats have been more willing to admit to Obamacare鈥檚 flaws. The Dems agree that the rising costs of marketplace plans are the chief complaint they hear about, too.
Democrats have also said if the Republican聽repeal effort聽fails, they鈥檇 be willing to聽. But it鈥檚 not clear the parties could agree on one that would help people like Anklin.
If they can鈥檛, Anklin said, she has no choice but to continue to go without coverage. Financially, it makes sense in the short term, but she still worries about an unforeseen surgery, serious illness or accident.
鈥淚f I ever have a problem,鈥� she said, 鈥淚 know I will be paying for the rest of my life.鈥�
This story is part of a partnership that includes , and Kaiser Health News, an editorially independent program of the .