http://kcur.org/post/small-missouri-town-went-trump-now-some-fear-health-care-overhaul-0#stream/0

The closest emergency room is 20 miles east on the highway. That’s why it isn’t unusual for people experiencing heart attacks, blood clots and strokes to show up at Dr. Rodney Yager’s clinic on Main Street in Monroe City, Missouri.

Yager, who grew up in the area, can handle the fast pace of a small-town clinic. What worries him more is how federal health care policies being shaped in Washington, D.C., could affect his patients.

The most recent proposal by Senate Republicans would cut taxes for the wealthy and leave 22 million more U.S. residents uninsured by 2026, compared to current law.

But voter frustrations with the Affordable Care Act’s rollout in communities like Monroe City helped fuel the elections of candidates who promised to dismantle it.

“Honestly, I can see the Republican side of wanting to make budget cuts and try to eliminate waste,” Yager said.”But at the same time, they’re hurting a lot of people.”

This town of almost 2,500 people sprang up about 130 miles northwest of St. Louis, along the railroad in the 1850s. Monroe City, which is just west of Hannibal, was once a Democratic stronghold in northeast Missouri. In the last decades, voters have shifted to favor conservative Republican candidates and their policies. In the most recent presidential election, Monroe, Marion, and Ralls counties voted for Republican Donald Trump over Hillary Clinton, his Democratic rival, by a 3 to 1 margin.

Nevertheless, Democratic U.S. Sen. Claire McCaskill received a warm welcome at the Monroe City Senior Nutrition Center last week, where she held her eighth of 10 town halls during the Senate’s July 4 recess. Her Republican counterpart, Sen. Roy Blunt, held none, a decision that drew protests in the St. Louis area. Members of Blunt’s staff said he met with constituents one-on-one throughout the week.

McCaskill is in a tough spot. Her six-year term will be up at the end of 2018, and she’s running for re-election in an increasingly red state. But in Monroe City, about 60 people listened as she vowed to vote against the latest Republican plan to gut the Affordable Care Act, and reiterated a call for Republican senators to accept amendments proposed by Democrats.

“It’s really a big tax break for wealthy folks, paid for by cutting the Medicaid program,” McCaskill said. “So I’m hoping it doesn’t pass. And then we can sit down together and try and fix what we have, repair what we have.”

It took just three questions before someone asked whether health insurance should be the basis of a health care system at all. Nearly everyone in the room raised their hands when McCaskill asked who would favor extending Medicare coverage to everyone, of any age. The idea of a single-payer system for American health care is a non-starter for conservative lawmakers and think tanks, but has grown in popularity among the general public. A recent Politico poll found that 44 percent of respondents would support a federal health care program for everyone.

“Even though more of you are for ‘Medicare for all,’ I’m worried that we can’t afford it right now,” McCaskill told the crowd. “It’s very expensive.”

Like many small towns in the United States, Monroe City’s population is aging. While voters are more likely to cast their ballot for Republican candidates, they are disproportionately affected by cuts in public spending for health care programs.