Affordable health insurance is already hard to get in many parts of rural America. Repealing the Obamacare mandate will make the situation worse. Photo: Spencer Platt/Getty Images

There has been considerable talk of the national effect of repealing the Obamacare health-insurance-purchasing mandate, which the president wants, and which is currently part of the Senate tax-cut bill. A revised Congressional Budget Office estimate suggests as many as 13 million people could lose health insurance over ten years, with individual premiums going up about 10 percent a year — a price Senate Republicans appear ready for other people to pay in exchange for the symbolic strike against Obamacare and $338 billion to devote to tax cuts for corporations and the wealthy.

Now we have some new analysis from the Los Angeles Times on how the mandate repeal might affect specific parts of the country. And it’s bad news for the rural people of Trump Country.

There are 454 counties nationwide with only one health insurer on the marketplace in 2018 and where the cheapest plan available to a 40-year-old consumer costs at least $500 a month. Markets in these places risk collapsing if Congress scraps the individual insurance mandate.

These areas are at risk because repealing the mandate — a significant incentive to younger and healthier people — could make the mix of participants in the risk pools for Obamacare too old and too sick to be sustainable at affordable rates, leading insurers to abandon them.

Eighty-six percent of these 454 at-risk counties have fewer than 50,000 residents, census data show. Healthcare costs are often higher in rural areas, as there are fewer medical providers and populations tend to be older and sicker.

These counties also overwhelmingly supported Donald Trump last year, with 9 out of 10 backing the Republican presidential ticket, according to election data.

In addition to Alaska, Iowa, Missouri, Nebraska, Nevada and Wyoming, the counties are clustered in southwestern Arizona, western Colorado, southern Mississippi, central North Carolina, as well as parts of Georgia, Virginia and West Virginia.

It’s unlikely Republican senators from these states will bat an eyelash at the prospect of screwing over their constituents via much higher premiums or the complete collapse of Obamacare markets. After all, most of them voted again and again earlier this year to screw over red-state white working-class Americans by deeply cutting Medicaid as part of their various Obamacare repeal-and-replace bills. And the psychic value of sideswiping Obamacare in a tax bill — sort of like a second helping of dessert after a Thanksgiving feast — is almost literally priceless to conservative ideologues.

Many of the people affected by this measure probably don’t much like the idea of being told they have to buy health insurance. But they’ll like having no real access to health insurance even less.