Kerry Reed spent the second week of April experimenting with canned corn and tortilla chips. Tacos were on the menu. She worked some of the corn products into them, just to see how her body would react. For now, anyway, she could still afford the treatment if something went wrong.
Reed, a 46-year-old freelance grant writer, has a rare disease that can make her suddenly and unpredictably allergic to different foods. She has health coverage through the Affordable Care Act, but she might not have it next year. So she is testing herself for allergic reactions while she can still buy her EpiPens and inhalers.
"If I can figure out how to keep my reactions under control and get really stabilized by September, that would be good," Reed says. "I can't really be in the middle of some new treatment going into next year."
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Congress is far from repealing Obamacare, but in eastern Tennessee, where Reed lives, the law could vanish next year whether a vote happens or not. Its residents cannot sign up for the law's Medicaid expansion because the state does not participate in that program. Next year, those residents may not have the option to use Obamacare's health marketplaces either.
As it stands, no insurers want to sell Obamacare coverage in Reed's area of Tennessee. Reed's current health insurer, Humana, recently announced it would quit selling such plans in 2018. The people signing up for the law, the insurer said, were sicker than expected. Humana didn't think the problem would get any better.
Tennessee is a preview of what an Obamacare collapse could look under President Trump, where the law technically remains standing but people don't have access to the programs.
The areas most at risk for this type of collapse are those that voted for Trump: places that are lower-income and rural, which aren't attractive markets to health insurance companies.
These are places that have struggled to attract robust insurance competition both before and after the health care law's implementation. "In general, rural areas have always been the places where it's hard to attract a competitive insurance market," says Aditi Sen, an assistant professor at the Johns Hopkins Bloomberg School of Public Health who has studied the health law marketplaces. "The incentives to enter just aren't that strong."
The Obama administration worked hard to recruit health insurers to sell to those areas. The Trump administration, however, seems to want to stand aside and let Obamacare run on autopilot, so it can explode or survive on its own.
In eastern Tennessee, that could have the practical effect of leaving 40,000 current Obamacare enrollees without coverage.
Reed is preparing for that possibility. So it was corn tests the second week of April. It was tomato sauce the week before that, which turned out to be a no-go; it gave her hives. Pineapple, one of her favorite fruits, is next. She tried to do allergy shots, but ironically, she was allergic to a non-active ingredient in the testing strips.
"I'm just trying to create a bubble around myself, and figure out how I can keep myself safe," she says. "I don't want to experiment, but I'm also trying to prepare myself for what is the minimum amount of medicine I can live with."
Insurers are supposed to announce by June 21 whether they'll sell coverage through the marketplaces. Reed is running out of time.
So is Tennessee.