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Obamacare in Trump county: why voters remain confident the president-elect will fix the health law

There is this county in Southeastern Kentucky that has seen some of the biggest gains in coverage under the Affordable Care Act — but also voted overwhelmingly for Donald Trump in the 2016 election.

Over the past few months, Vox video producer Johnny Harris and I have been spending time there to understand why. What motivated the people in this place, Whitley County, to vote for a candidate who expressly promised to take away their health insurance?

Our guide to Whitley county has been Kathy Oller. She’s an Obamacare enrollment worker who has signed up more people for coverage than she can count. She’s also a Trump supporter, which surprised me when we first met in December.

Oller says she voted for Trump because she sees problems with the health care law — the premiums and deductibles have gone up a lot over the past few years, and people struggle to afford coverage. She felt that Trump would do a better job at fixing those issues.

Johnny and I have both spent a lot of time talking to Oller about health care — and about a lot of other things, too. She is warm and funny, and has a story to tell in nearly any situation. When she signs people up for coverage, she sits close to them, explaining how Healthcare.gov works and all the different health care jargon they need to know.

Earlier this month, we invited Oller to come to Washington, DC, for Vox’s interview with President Barack Obama. She asked Obama a question about the health care law — she wanted to know why the plans had become unaffordable — and received an eight-minute response.

Oller later described meeting the president as an “out of this world experience.” She was “so excited” that he would listen. But she still expects that it is Trump, rather than a Democrat, who will get the health care law back on the right track.

“He is a businessman so I know he has to have something to replace,” she said in an interview last week. “We just don’t know what yet. We don’t know if it’s for the best or worst, but it’s got to be better than this.”

The Obamacare enrollment worker who voted for Trump

Kathy Oller signs up Kentuckians for health care coverage in Corbin, Ky. Byrd Pinkerton/Vox

Oller thinks that Obamacare has done more good than harm for the area of Kentucky where she works. She has signed up lots of people who never had coverage before. “Some of them were so excited because they hadn't had insurance,” she says.

But over time the costs of coverage in Whitley County went up — just like they did nationally. And Oller found that more people she signed up were facing challenges paying their premiums and deductibles.

“I don't know what happened,” Oller says of the costs. “It's just getting outrageous.”

Oller likes the idea of universal coverage. She supported President Obama in 2008 and 2012 specifically because of his promises to expand affordable health insurance. But in 2016, she decided to vote for Trump. In part, she felt it was a bit of a toss-up. She kept describing voting as something akin to “Russian roulette” — you never really know what you’ll get with a candidate, she argued.

But Oller had a feeling that Trump would do better for the people of Southeastern Kentucky than Obama — that he would fix the health care law, and replace it with something that provided more affordable coverage.

Johnny and I, on two separate trips to Kentucky, found lots of voters who agreed with her. They talked about unaffordable deductibles a lot — how they wouldn’t go to the doctor because they’d have to pay so much out-of-pocket before their coverage actually kicked in.

There was a nearly uniform and unshakeable belief among the people we spoke with that Trump’s promises of Obamacare repeal were just campaign bluster — that the Republican nominee wouldn’t actually take away health insurance from people who had just gained coverage for the first time in their lives.

“I just thought he would have some change, different ideals and views,” Oller said, explaining her vote.

Republicans are moving quickly on repealing Obamacare and replacing it with a new policy. The current proposals suggest that policy will be better for the young, rich, and healthy — but worse for the poor, sick, or old. The type of people we spoke with in Kentucky are those at risk of being disadvantaged by some of the replacement ideas.

“How can we fix it? Do we start all over again?”

In early January, Ezra Klein and I had the opportunity to interview President Obama about the Affordable Care Act. We did so in front of an audience, and asked Oller to join us. She would be the one audience member who asked a question — one that she spent hours preparing.

This is what she asked the president:

Over the years, I’ve enrolled and talked to numerous Kentuckians and have signed up some the first time. It was working.

But recently we found out there were fewer choices in our areas, and the increase in the premiums and deductibles — some of our facilities aren’t even taking them. Many Kentuckians are looking at the Affordable Care as unaffordable and unusable.

And I have the opportunity to ask you a few questions that you have probably went over, but how do you think this happened? How can we fix it? Do we start all over again? What do you think we should do?

Obama told Oller that the parts of Obamacare that frustrated her frustrated him too. He wanted to make the plans more affordable by increasing subsidies, but Republicans had not wanted to support these kind of changes to the health care law.

“This is my main criticism of Obamacare, of the Affordable Care Act: The subsidies aren’t as high as they probably should be for a lot of working people,” Obama told Oller. “If you don’t qualify for Medicaid where you don’t have to pay, for the most part, for your coverage, and instead you’re buying health insurance on the marketplace. So you’re a working person but you don’t have a lot of money, and particularly if you are older … then there are families where the premiums are still too high.”

“He is a businessman, so I know he has to have something to replace”

Oller came back to Vox’s office after the White House — and she seemed to be over the moon about meeting the president. She talked about how in-depth his answer was, how she appreciated that he seemed to really listen to her question and heard the concerns she voiced from the people of Southeastern Kentucky.

This made me curious: Did Oller have any regrets about her vote? Does she now think that maybe it was a Democrat, rather than Trump, who would do better at fixing the Affordable Care Act?

She didn’t. Johnny had a FaceTime conversation with Oller this past week, and she still believes that Trump will make Obamacare work better — that because of his history as a businessman, he will come up with a better plan.

To be clear: Trump did release an Obamacare replacement plan during the campaign, and independent estimates found that it would increase the number of uninsured by 21 million people. Other Republican proposals also lead to millions losing coverage, too.

But Oller had made her decision: She felt like where people are right now, where they can’t use their coverage because the deductibles are so high, is the worst possible situation. She felt like things couldn’t get any worse for the people she has signed up for coverage.

“I’m confident he’s going to have another plan,” she says.