The mothers and daughters who have been cleaved apart by Donald Trump's assault on Obamacare

David Usborne

Before last year’s election, Thea Crane tried to talk to her family about how Obamacare had saved her life. Both her parents voted for Donald Trump anyway, as did two of her three siblings, including a brother so angered by her political views that he barred his two daughters from speaking to her.

Alaina Comeaux battled last year to explain to her mother that the law passed seven years ago, known as the American Care Act, ACA, had spared her from a certain “death sentence”, yet she too took no heed and voted Trump. Now mother and daughter can’t discuss politics at all.

The challenges faced by these two young women is as vivid an illustration as any not just of how profoundly divided the United States has become as Mr Trump tries to deliver on his pledge to repeal and replace Obamacare but also of the profoundly grave consequences that the changes he and the Republicans are contemplating may have for real people in the real world.

Both 27 and living in Louisiana, among the poorest and least healthy states in the nation, Ms Crane, who suffered a mini-stroke as a teen and still has blood clotting problems, and Ms Comeaux, a victim of Crohn’s, a potentially fatal auto-immune disease, are as terrified of the future as they are grateful for the protection that Obamacare has given them until now.

“It was a bleak outlook for me without Obamacare,” Ms Comeaux, a teacher in New Orleans, explained. “I was probably 21 when it passed and for the first time I was able to look forward to the future.” Because the new law barred insurers from refusing people with pre-existing conditions she found a plan that took care of all her expenses, which in a good year easily top $100,000. She needs infusion treatments every two months, costing $22,000 each time.

“Normally, I would pretty much be uninsurable,” noted Ms Crane. “I am kind of a ticking time-bomb, they don’t know when or if I could have another episode but they know I am predisposed to blood clotting issues. The potential costs to them would be astronomical.” She too has coverage she fears she might soon lose.

It is because she has seen it in her own family – in her words “very white and very Catholic” and all living in Fargo, North Dakota – Ms Crane knows that no appeals for compassion or even common sense will be enough to stop the Republicans in Congress as they hurtle, albeit rockily, towards scrapping a law they see as government meddling in the marketplace and the evisceration of which has been at the heart of their political messaging from the day it was adopted back in 2010.

“They just don’t see all the kinds of faces that are affected,” Ms Crane says, sharing a small table at the Bakery Bar on Annunciation Street in New Orleans. Republicans, she contended, have “this preconceived notion” that Obamacare was conceived for Americans already dependent on government hand-outs. “That’s just not the case at all,” she argued. A lawyer just starting out, she often works 70 hours a week, mostly from home.

Obamacare has been transformative for Louisiana, particularly since July last year when the then newly elected Democrat governor, John Bel Edwards, reversed the policy of his Republican predecessor and agreed to embrace provisions in the law that allows states significantly to loosen the requirements for residents to qualify for Medicaid, aimed at the poor.

Thanks to Medicaid Expansion, as it is called, almost half a million residents of Louisiana will have health coverage where they didn’t before by the middle of this year, a much higher number than was expected – all people who can now go to a doctor when they fall ill, not the hospital emergency room. Moreover, the state’s health department reports that 58,000 Louisianans have received preventative care as a direct result, that includes 5,400 previously uninsured adults having colon cancer screenings, of whom more than 1,500 had polyps removed.

Few people are as focused on what the Republicans, led by speaker Paul Ryan, are proposing as the replacement for the ACA, than Susan Todd, the executive director of 504HealthNet, an association of health clinics across New Orleans and the surrounding counties. She is appalled by the plan, which would replace direct subsidies for people buying plans with much less generous tax credits and force Louisiana to end its entire Medicaid expansion programme.

“What they have done is just go back to where we were before and that was no great place to be,” she explained in her office above a clinic run by a Catholic charity on the edge of the Lower Ninth ward. “I mean, why do we want to go back there? We know that this is going to impact hospitals, we know that this is going to impact peoples lives.” An immediate result, she said, would be a scaling back by all her clinics as patients lost the plans and funding dried up.

While some seethe, others are resigned to the damage they see coming. “With our president right now, I just expect the worst of everything, nothing can surprise me by being bad with what the administration is doing now,” commented Mark David LaMaire, a bass player who saw his plan, purchased through a local musicians union, transformed last summer when the Medicaid Expansion kicked in. Under the Ryan plan, it would go back to bare bones.

“I know all the worst stuff is happening,” Mr LaMaire, 37 years old and healthy, commented as he tidied away a stall at a farmers market in Uptown New Orleans where he cooks and sells Burmese food. “Everyone is so worried. Their stress levels is a health problem in itself.”

Not so fortunate is John Williams. Now 37, he was diagnosed with multiple sclerosis, MS, when he was 21, an event that forced him to seek a government job with health insurance benefits. When Obamacare was passed, he was able to set up his own small legal practice. But like others, he is fearful that, in spite of promises to the contrary, whatever replaces it will either see the the pre-existing conditions provisions erased or couched in terms that will allow insurance companies to demand ever soaring premiums.

“If that happens it will be a parade of horribles for me,” Mr Williams explained in his cubby hole office alongside the tracks of a New Orleans streetcar. “Whether I have health insurance or not really dictates my life.” In a remission-relapse phase he is always fearful of another outbreak of his MS, affecting muscular movement and, in his case, his vision. The first consequence of the Obamacare repeal will be his giving up his practice and seeking employment with health coverage. Aside from regular MRIs, he needs intramuscular injections costing $5,000 (£4,045) month.

He wonders if the Republicans understand the devastation they will bring to people’s lives just because of ideology. “Politics a lot of time turns into a lot of back and forth and banter but when it’s real, when it’s about me not getting my medicine or the treatment I need, people need to say like, ‘Yo, enough with your back and forth, I need to get what I need to stay alive’.”

Katherine B, who has a history of uterine fibrosis, says: “The Republicans are more interested in holding to their party value than serving the people and take care of the population.” Because of that condition, she concluded on the day Mr Trump was elected that her current situation, making a living as an artist, will no longer be tenable once Obamacare and the coverage it guarantees her has gone. It is because she is looking already for a full-time job with healthcare benefits – and because of her outspoken views – that she prefers to withhold her full name. “They are perfectly willing to let a lot of people lose coverage, which in no uncertain terms means a lot more people will die. They don’t connect the dots. Children will die.”

“I find it astonishing we are going down this road,” she offered. But just as with the Ms Crane and Ms Comeaux, she is struggling with something else. Her 83-year-old mother, whom she had just helped settle in hospital because of a skin infection, also voted for Mr Trump last November, in spite of Obamacare being a vital guy-rope of her daughter’s life. “It just blows my mind. It’s just, ‘Wait, how could that be?’” she attempted. “We don’t talk about it. We decided a long time ago not to talk about politics. She has always been Republican, which I find bizarre.”

Silence has never been the strategy of Ms Crane, however, which goes some way to explaining why Facebook chats with her nieces back in North Dakota have now been forbidden. “There have been a lot of angry, tearful conversations,” she admitted. “They didn’t know what to say. I broke it down very simply for them. It’s been really tough on the family.”

But persuading her parents and siblings that they did her wrong by voting for Mr Trump is ultimately a pointless – and hopeless – mission, she conceded. “At the end of the day, they can’t take it back now even if they wanted to.”