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We’re hearing a lot of stories about how Senate Republican efforts to repeal and replace Obamacare are in trouble. Recently Jennifer Steinhauer and Robert Pear reported that things got worse for the GOP over the July 4th break. The interesting thing they noticed is that the erosion of support for the bill is coming predominantly from Republican Senators who represent more rural states.

A week that Senate Republicans had hoped would mobilize conservatives and shore up support for their measure to repeal the Affordable Care Act instead ended with eroding enthusiasm, as usually reliable Republican senators from red states blanched at its impact on rural communities.

Ever since Republicans started putting forth their plans to repeal and replace Obamacare, we’ve heard countless stories about how the Medicaid cuts would disproportionately impact people living in small town and rural America. But that’s not the only thing that is at stake for these communities. Because so many hospitals and providers depend on reimbursement from Medicaid for their financial survival, their existence could be threatened by Republican attempts to scale back the program. That doesn’t just impact providers.

In rural areas where people tend to be older and sicker and have lower incomes, many hospitals say they are already struggling to survive and would be hit hard by the cuts to Medicaid in the repeal bills.

“I talked with the marketing director of the small hospital in Greenville, Maine, yesterday at lunch,” said Senator Susan Collins, Republican of Maine, who has opposed the bill. “She told me that the hospital is the biggest employer in town, with 180 employees, and that it relies on Medicaid for 65 percent of its revenues. It is unlikely that this community hospital could survive the cuts that are in the Senate bill.”

“In addition, if it were to close, the economic blow would be devastating because of the loss of so many good-paying jobs,” she continued. “I am not surprised that those of us who represent rural states that would be particularly hard hit by the Medicaid cuts tend to be particularly concerned” about the impact of the bill.

Possible Republican defectors include John Hoeven of North Dakota, Chuck Grassley of Iowa, John Boozman of Arkansas, Jerry Moran of Kansas, and Bob Corker of Tennessee. Sen. Joni Ernst of Iowa seems to be signaling concern on another issue.

That’s a pretty clear swipe at her friend Sen. Ted Cruz, whose amendment would threaten coverage for those with pre-existing conditions.

As we’ve seen explained by multiple sources, Republicans in the Trump era are almost completely dependent on support from small town and rural America. The fact that so many of them are now having to defend Obamacare provisions is fascinating to watch. Who knew that the most powerful message for Democrats in these regions of the country would become support for Obamacare?

Nancy LeTourneau

Follow Nancy on Twitter @Smartypants60.