NEW RINGGOLD, Pa. — Among the groups hardest hit by the Republican plan to replace the Affordable Care Act is one that swung for Donald Trump during last year's presidential race — older Americans who have not yet reached Medicare age.
Many of those who buy their own health insurance stand to pay a lot more for their coverage. That is especially true for the nearly 3.4 million older Americans who have enrolled through the government marketplaces, many of whom receive generous federal subsidies through the health care law enacted under former President Barack Obama.
Health care experts predict those older adults will end up buying skimpier plans with lower coverage and higher deductibles because that's all they will be able to afford. The Republican plan replaces the subsidies in the Affordable Care Act, which mostly benefit low- and middle-income earners, with a flat tax credit that does not take into account income or local insurance prices.
On top of that, the GOP plan allows insurers to charge older people five times what they charge younger customers, compared to three times under Obama's health care law.
The Republican plan is still evolving, and many GOP lawmakers have said they want to see changes that reduce the impact on older consumers before they can support it.
Based on the current plan, an Associated Press analysis of data from the Kaiser Family Foundation shows older consumers, defined as those age 55 and older, would be disproportionately affected. They could lose thousands of dollars per year in government subsidies for health insurance.
The AP analysis also found that on average, the counties with the strongest Trump support will see costs for older enrollees rise 50 percent more than the counties that had the least amount of support for Trump.
"A lot of people just won't be able to afford to pay it. A lot of people are going to drop out of the market altogether," said Kaiser's Cynthia Cox.
That includes older voters who helped put Trump into office.
Take Schuylkill County, Pennsylvania, an economically struggling former coal-mining center where the New York billionaire won 70 percent of the vote in November.
About 40 percent of Schuylkill County's Affordable Care Act enrollees are 55 or older, more than 10 points higher than the national average. A 60-year-old making $30,000 annually here will pay roughly $8,750 more per year for coverage under the Republican plan moving through Congress, according to the AP analysis.
"When it comes to food or insurance, it's going to be an easy choice," said Matt Strauss, a health insurance broker in New Ringgold, some of whose customers voted for Trump.
Older Americans on both ends of the political spectrum say they are worried about what the future holds. Here are some of their stories:
Trump supporter and longtime Republican Robert Ruscoe, who runs a Florida liquidating business with his wife, said he is not feeling "warm and fuzzy" about the GOP health care plan.
He went about five years without insurance because it was financially out of reach. When insurance became available through the Affordable Care Act, the couple was able to get a policy for about $350 per month, after a $700 monthly subsidy from the government.
"It's nice to be able to go the doctor whenever something comes up. It gives you a peace ... especially when you get close to 60," said Ruscoe, 57, of West Palm Beach.
He said he didn't hesitate to sign up through the Affordable Care Act, a program his party spent years vowing to dismantle.
"It doesn't matter who came up with it. It's a good thing to be supporting across party lines," he said.
Worried about losing coverage, Ruscoe considered voting for a Democrat for the first time last November. But he ultimately placed his trust in Trump and the GOP.
"Obamacare is eventually going to have to be fiscally sound. Otherwise it's not going to stay," Ruscoe said. "I figured (a replacement) was coming, anyway."
He said he wants Trump to know that having access to insurance matters.
"That coverage made a big difference in a lot of people's lives, just like me," he said.
Anna Holloway of Norman, Oklahoma, who takes daily medication for an auto-immune disease, said she is fearful the GOP plan will price her out of the market for health insurance.
"I am conscious of just how desperate this is," said Holloway, 60, fighting back tears. "I try not to let myself feel this way, but to live this way with real terror, real fear that the universe is going to fall apart around me."
She takes home about $1,150 per month working four part-time jobs. That's only $250 more than the monthly premium for a health care plan that includes Holloway and her 23-year-old daughter. Without the government subsidy that makes the policy affordable, she would have to drop it.
The Kaiser analysis estimates a family plan in Norman under the current Republican proposal would cost as much as $20,000 more for someone in Holloway's income and age bracket.
"I'd go without health care. I would get sicker, and that would make it more difficult to work. I would eventually have to stop working," said Holloway, a registered Democrat who voted for Hillary Clinton.
Holloway said she has contemplated the possibility of selling her home and moving in with a family member in Virginia. She acknowledges sometimes feeling hopeless when she considers how losing her health care would affect her life.
"I'm not suicidal, but there are times that I think of the damage that could be done to my daughter and her future if I have to eat up all my reserves and my house and all that I own," she said.
The Affordable Care Act didn't work for Wendy Kline, a hairstylist in Harrisburg, Pennsylvania, who voted for Donald Trump.
Kline tried buying a policy on the federal exchange but found she made a little too much money to qualify for a government subsidy. So she was stuck paying the market rate.
Her policy jumped this year from $630 to $929 a month. As a result, the 61-year-old isn't able to save much for retirement.
"I try to put as much away as I can, but my health insurance is $30 less than my mortgage payment," said Kline, who works two jobs.
The GOP plan is a mixed bag for people like Kline. It gives some higher-income consumers the ability to get tax credits for coverage purchased off the exchange, but it also gives insurers the right to charge older customers like her more than they can under the current law.
Kline voted for Trump hoping he would be able to work with Congress "to make it affordable for everyone, across the board."
She said she still has hope, but is increasingly skeptical.
"I'm so tired of the whole thing," she said. "When they talk, I turn the television down because it just drives me crazy."
Retired factory worker Bob Melton, 63, said the projected cost increases for older Americans mean he and his wife Tammy, 58, would be unable to continue to afford coverage. They now pay $225 a month after the subsidies they receive through the Affordable Care Act.
He was staggered by a projection that the couple's premiums could go up by nearly $17,000 under the GOP plan.
"It'll put me and my wife out — out of insurance. There's just no way," he said.
Melton saw a doctor for the first time in 12 years after he and his wife bought a policy through the federal health insurance exchange in 2014. After three appointments and blood tests ruled out more serious ailments, Melton said he learned the nagging pain he suffered in his hands was caused by arthritis.
The Meltons live in Morganton, North Carolina, about 75 miles northwest of Charlotte, in a county that has seen an exodus of manufacturing jobs. Trump won more than two-thirds of the vote here.
Bob Melton himself used to be a staunch Republican. Now he blames Republicans in North Carolina for what he views as efforts to obstruct the Affordable Care Act from working as intended, by refusing to expand Medicaid coverage.
"There's no justification for it except for spite. That's just the way I feel about it," said Melton, who voted for Clinton.
Although he's grateful for his federally subsidized plan, Melton's experience highlights the diminishing options that have plagued those trying to buy health insurance on the government exchanges established under the Obama reforms.
Last year, Melton's coverage cost only about $37 after subsidies through Coventry Health Care, a division of Aetna Inc., but the company has since dropped exchange offerings in the state.
His current insurer, Blue Cross and Blue Shield of North Carolina, is the only choice available, and his monthly premium is up nearly $200.