SCOTT SIMON, HOST:
There have been several versions of the Republican repeal and replace bill, but none of them fix the real hole in the Affordable Care Act. That's affordability. In California, the state marketplace, Covered California, is one of the most stable in the country. The people who live in the rural northeast corner of the state still have complaints. From member station KQED, April Dembosky reports.
APRIL DEMBOSKY, BYLINE: Aaron Albaugh appears out from under the brim of his cowboy hat, surveying the acres of hayfields in front of him. Right now he's in charge of more than 400 cows.
AARON ALBAUGH: Each one has their own personality, and they're wired differently. And some of them you like being around, and some of you'd just as soon not have to deal with (laughter).
DEMBOSKY: This corner of California is remote. Albaugh's closest neighbor lives a half mile away.
ALBAUGH: And that's my brother. We live on the same ranch. If I want to go see a movie it's 70 miles round trip. If I want to go bowling that's a hundred miles round trip.
DEMBOSKY: Living a half day's drive from civilization, Albaugh says you learn to do without. If your refrigerator breaks, you put your food on ice until the weekend when you can go buy a new one - same thing with health care.
ALBAUGH: Put a Band-Aid on it. I was raised, you know, you're - you don't need to cry and to suck it up, buttercup. And that's kind of the way I still live. And I try to treat my kids the same way.
DEMBOSKY: So when people are already used to doing without health coverage, it's particularly annoying to have the government say you have to buy it. Just like the movie theater, most doctors are miles away.
In Modoc County, there's nowhere to have a baby. Tessa Anklin gave birth to her son in Klamath Falls, Ore.
TESSA ANKLIN: Which is actually an hour and a half from here.
DEMBOSKY: Anklin makes about $15 an hour as a receptionist. Her husband does seasonal work baling hay and herding cattle. Two years ago, they had a plan through Covered California, and with the subsidy they paid $2 a month.
ANKLIN: We had a $10,000 deductible. So really we had nothing.
DEMBOSKY: Then last year, her monthly premium jumped to $600. She's not sure why. It was likely a technical glitch because it was the same plan, same household income, same hour-and-a-half drive to see doctors they almost never need. Anklin thought of all the other ways she could spend that money.
ANKLIN: It makes a car payment. It's certainly almost your mortgage payment, groceries for at least four months (laughter).
DEMBOSKY: That's the reason she decided to cancel her health plan this year and go without. But she still has to pay a penalty. Anklin says she'd be happy to see Obamacare go.
ANKLIN: To me, it's no good. To me, it's no good if you have to force people to pay yet another something out of their paycheck when they're already trying to survive with what they have. It should be an option.
DEMBOSKY: But under the Republican repeal and replace plan, Anklin's premiums would go up to more than $2,000 a month. And that's not what she had in mind.
ANKLIN: I'd love that insurance could be more affordable for families that need it, for families that work hard for it.
DEMBOSKY: With the Republican bill in limbo, Democrats have been more willing to admit to Obamacare's flaws. And there are fixes that have gotten bipartisan support in the past. But it's not clear if the two parties can agree on one that helps rural Americans like Anklin. For NPR News, I'm April Dembosky in Modoc County, Calif.
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SIMON: This story is part of a reporting partnership between NPR, KQED and Kaiser Health News.
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