James Acker is a Donald Trump supporter deep in Minnesota Trump country. Cass County voted two-to-one for Trump over Hillary Clinton in last fall's presidential election.
Acker and some of his neighbors, however, are not sold on what they've heard from Trump and other Republican lawmakers on Medicaid. The federal health safety net plays a crucial role here and many residents are worried now about the GOP's push to remake health care and how that will affect them and their communities.
Republicans unveiled their latest plan for changing the Affordable Care Act after strong pushback about Medicaid and other cuts.
Many in Cass County are watching intently. Despite the overwhelming support for Trump, people are wary about changing a program that for many is a life-or-death necessity.
Acker, 42, said he knows people who benefit from Medicaid and that people are concerned about the program's future. He "absolutely" believes the GOP plan to overhaul Medicaid funding goes too far.
"As far as cutting it, I think it's wrong because there's a lot of people still in need of it, especially in this area."
Medicaid delivered nearly $93 million to Cass County last year, according to the Minnesota Department of Human Services. The money provided help to 8,669 people, roughly one out of every three county residents. Two-thirds of recipients were families and children.
Disabled and elderly people made up just 12 percent of Medicaid enrollment last year but accounted for almost half of the spending, more than $40 million for 1,036 people.
Assistant Minnesota Human Services Commissioner Nathan Morocco said the initial Senate Republican plan would eventually cost Minnesota 30 percent of projected federal Medicaid money — more than $5 billion a year. That would force cuts to Medicaid in Minnesota, he said. "There's no way the state could, in any way, find a way to fill that budget gap."
During a recent walk around the Cass County Fair in north-central Minnesota, it was hard to find anyone who wasn't aware of the debate over Medicaid. Most said they're concerned about proposals to cut the safety net's funding.
"I'm actually fed up ... pretty fed up with it," said Victoria Stumbl, 29, who lives in near Backus, Minn.
She's got three children, is six months pregnant and relies on Medicaid to pay for the family's health care. Stumbl said she and her husband avoid news coverage of the Medicaid debate. The prospect of losing their health coverage is just too stressful.
"It freaks me out and it stresses me out," said Stumbl, who said she did not vote for Trump.
Donna Wilson, 50, lives in nearby Crow Wing County, which also voted overwhelmingly for Trump. She voted for him, too, but said she thinks Republicans have come to understand most Americans think deep cuts to Medicaid are not the answer to the nation's health care problems.
"It's not a good plan," she said, "and that's why there's a lot of push back."
Correction (July 17, 2017): A previous version of this story misidentified Nathan Morocco's title. The story has been updated.