The affordable care act has always been in the crosshairs of many congressional Republicans. However, many of the rank and file Republicans support specific provisions of the law that would go away if it were repealed.
Coal country benefits from the ACA
The ACA may be opposed by a lot of people out in so-called coal country when it's referred to as Obamacare, but many people from the region support a special provision of the law. Coal miners tend to get black lung disease. Prior to the law, it was on the miner to prove he got the disease directly from the job.
This was a lot harder than it sounds as coal companies got the courts to go along with all sorts of justifications and doctor shop to get a couple doctors to say coal mining didn't cause the disease. This led to people, many of them poor and elderly, being unable to get coverage.
The ACA was a game changer. Now coal companies had to prove that miners didn't get the disease from the mines. This made black lung disease coverage easier to obtain. However, if this provision were to be left out of a replacement, coal miners, who made up a great deal of Donald Trump's base, would be in a tough situation. Many of his voters are worried about what will happen if they lose their coverage. Sen. Joe Manchin (D-W.Va) reports receiving countless calls from concerned coal miners.
The ACA also helps disabled people
Most disabilities qualify as pre-existing conditions. Everything from cerebral palsy to autism was declared a pre-existing condition by multiple health insurance companies, if not all of them. It was nearly impossible for the disabled to get any sort of insurance on the private market. Most insurance companies just told families to get them on Medicaid as soon as possible.
The ACA fixed that. People who would once be tossed to Medicaid or high-risk pools that covered almost nothing could now get coverage.
More importantly, though almost completely unnoticed by the media, and nearly unmentioned by Democrats, is the Community First Choice Option.The basic idea of the act is that Medicaid, rather than pick nursing homes as the first option, as they did previously, now had to pick community-based settings.
People were being freed from nursing homes and other institutions. They were able to live in their own home. Groups like ADAPT had fought for this provision for decades and have recently been protesting outside of Sen. Paul Ryan's (R-WI) church.
The media allowed many of these provisions to go unnoticed. As these things now get noticed, people on both sides are worried. This may prove to be a problem for the Republicans.
