Jane Harrod, a landscaper in central Kentucky, was installing ahog fence on her family farm with a “spud bar,” a long, irontool often used as a lever to move rocks. Suddenly, she recalled,it “came like a rocket and hit me in my forehead.”

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Related: 1 in 4 Americans skip medical attention because ofcost

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The blow, back in November 2014, didn’t leave a bruise, butthe next morning she couldn’t see out of half of her righteye. Harrod’s retina was detaching, and a doctor told her sheneeded urgent surgery to avoid permanent blindness.

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“I don’t have insurance, and I don’t have a lot of money,”she told him.

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Harrod, 64, makes about $14,000 a year from landscaping,care-giving jobs, and working on the farm with her siblings. It’sbeen in her family since 1804. Baptist Health Hospital inLexington, Kentucky, helped her sign up for a health planunder the Affordable Care Act that cost about $125 per month. Thecoverage paid for most of the $6,000 eye surgery, months offollow-up care, and an additional cataract procedure a year laterthat restored her vision.

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“No doubt, that was a lot of financial help right there,” Harrodsaid. The insurance allowed her to stay in the workforce andreturn to the tough, outdoor labor she’s done her whole life. “Iwould cost the system a lot more if I were on disability and onfood stamps, and if I went in and said I just can’t functionanymore,” she said.

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Since the 1970s, as America’s income gap has widened, one of themost powerful drivers of inequality has been the growing costof health care.

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The ACA, President Barack Obama’s signature domesticachievement, expanded the safety net for people suchas Harrod, who lived one bad turn away fromfinancial disaster, extending coverage to about 20 millionAmericans and cutting the share of uninsured by almost half since2013.

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Related: Uninsureds once again on the rise

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Soon, it may be a thing of the past. Senate Republicans, havingreturned from their July 4 break, resumed negotiations toreplace Obamacare with legislation that could lead to 15million fewer people being insured next year, and 22 million fewerby 2026, according to the non-partisan Congressional Budget Office.

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Some insurers are exiting the state marketplaces created by theACA, leaving parts of the country with no insurers sellingObamacare plans. Republicans cite these departures as evidence thatthe law is failing and needs to be replaced.

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Related: 5 areas likely to lose ACAinsurers

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Senate Majority Leader Mitch McConnell, a KentuckyRepublican, has said that a bipartisan plan to stabilize themarketplaces will be needed if his divided caucus can’tagree on a replacement. Democrats counter that the shaky state ofObamacare is directly related to a refusal by Republicans tosupport it since its passage.

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If the current GOP effort to roll back the lawsucceeds, it’s not just health care that may suffer. Economicinequality and health disparities are linked, and replacingObamacare is likely to make the twin problems of financialinsecurity and poor health worse for those at the bottom of theincome ladder.

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“We do know that people who are healthier are more productiveand are more likely to work,” said Barbara Wolfe, a healtheconomist at the University of Wisconsin-Madison. “We alsoknow that the people who are most affected by the expansion [ofhealth coverage], and would be most affected by cutbacks, arepeople with lower incomes.”

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The Senate bill in its current form would cut taxes on thewealthy and the medical industry, reduce subsidies for insurancecoverage, and, for the first time in U.S. history, cap the growthof federal Medicaid spending.

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The proposed reductions in this state-federal program forlow income and disabled people, created under President LyndonJohnson as part of his Great Society initiatives, “dwarf theincreases that occurred through the ACA,” said Henry Aaron, aBrookings Institution economist.

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In 2014, Aaron estimated that Obamacare would have a cleareconomic effect, boosting the incomes of the bottom fifth ofAmericans by from 3.4 to 5.3 percent, depending on how healthinsurance is valued. If the Senate bill's cuts to Medicaid becomelaw, those gains would be reversed and then some. The CBOestimated that, in 20 years, federal funding for Medicaid would bereduced by 35 percent compared with current law.

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The country’s lopsided income distribution is mirrored in itsvital statistics. The top 1 percent of Americans by this measurelive an average of almost 15 years longer than the bottom1 percent, according to a study of tax and death recordspublished last year in JAMA. Like income gains, health improvementshave been concentrated at the top.

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Related: GOP facing pressure from all sides on Medicaidexpansion

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From 2001 to 2014, life expectancy for men in the top5 percent by income increased two years and four months; for women,by almost three years. In the bottom 5 percent, men gainedfewer than four months, and women’s average life expectancyincreased by just two weeks.

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Some conservatives argue that expanding health insurance hasn’tbeen shown to improve health. In fact, having coverage wasn’tmeaningfully linked to longer life expectancy in the JAMA analysis.A rigorous study in Oregon of people who were randomly selected toget Medicaid coverage failed to find gains in physical health overtwo years.

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Related: Two studies look at Medicaid expansion pros,cons

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Medicaid did, however, improve people’s mental health, leadingto lower rates of depression. It also improved their finances,reducing out-of-pocket spending, medical debt, and catastrophiccosts.

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In Ohio, more than a million people have gotten Medicaidcoverage over some period of time since 2014 underObamacare. “Medicaid expansion is really about getting peopleready to work,” says Ohio Medicaid Director Barbara Sears.

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Three-quarters of those newly covered who were looking for worksaid being on Medicaid made it easier to look for jobs.Moreover, a majority of those employed said having access toMedicaid helped them stay on the job, according to a statesurvey.

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What’s the connection? Perhaps America’s opioid epidemic plays arole: Sears said she’s heard hundreds of stories of Ohioansstruggling with addiction who were able to return to the workforceafter getting treatment paid for by Medicaid.

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“If I have a mental health or addiction issue, I may beable-bodied but not work-ready,” Sears said. Sheadded that rolling back the expansion, which is funded mostlyby the federal government, would trigger larger state expendituresunder other, more expensive programs for the disabled.

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Ohio’s Republican governor, John Kasich, has urged SenateRepublicans to keep Obamacare’s protections for the poor.

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Related: GOP governors hope to protect Medicaidexpansion

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He and six other governors of both parties sent a letter toSenate leaders last month saying that the plan passed by the House,which is similar to the Senate plan, “calls into questioncoverage for the vulnerable and fails to provide the necessaryresources to ensure that no one is left out, while shiftingsignificant costs to the states.”

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Copyright 2018 Bloomberg. All rightsreserved. This material may not be published, broadcast, rewritten,or redistributed.

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