West Palm Beach, Florida (CNN) If it had been only about what was best for him, Bob Ruscoe would have cast his ballot for former Secretary of State Hillary Clinton. But he's a staunch Republican, always has been, and that meant this Obamacare beneficiary struggled over his November vote in a way he never had before.

"I agonized over the decision," he said. "Part of me was saying, 'if she gets in, at least we won't have to worry about health care for four years.' "

Ruscoe, 57, of West Palm Beach, Florida, is self-employed and knows the insecurity of going uninsured. He took advantage of the Affordable Care Act the minute he could.

About 20 million people gained health care coverage through Obamacare. With more than 1.7 million Floridians enrolled as of February, the Sunshine State has the highest percentage of Obamacare recipients in the country. And yet Ruscoe was among the majority of Florida voters who checked the box for Donald Trump, the candidate who promised time and again to spike the program Ruscoe couldn't wait to have.

"We'll have to see what pans out," he said. "It may not be totally repealed. It may be something else. I hope something will remain in place."

He went with the candidate he thinks will make America stronger.

"I did what I thought was correct for the overall good of the country," he said. "Economic strength cures a lot of things."

A better economy, he hopes, will free him from needing subsidies.

Having no choice

For most of his adult life, health insurance was a comfort Ruscoe took for granted. Between him and his wife, at least one of them had a job with health care benefits.

He left his position in ceiling fan sales to venture out on his own about 13 years ago, only after their daughter was grown, the house was mostly paid off and he had a little pension. Ruscoe is responsible like that.

Then, his wife lost her job. Other than the nasal polyps that have long plagued his sinuses, they were a pretty healthy pair. Plus, they had the option of COBRA coverage for 18 months.

That benefit ran out, though, and so did prospects for health insurance -- at least for him. Ruscoe weighed about 300 pounds at the time, and try as he might, he couldn't find a policy to cover him. He knew he could stand to lose some weight, but he'd been an amateur athlete and remained active and strong. He didn't see himself as unhealthy, but that didn't matter.

"They wouldn't sell it to me at any price," he said. "It was the reality of the situation. I didn't have a choice."

Still, Ruscoe, who's since lost 100 pounds, doesn't blame anyone but himself.

"I was overweight, so I was a risk," he said. "I wouldn't have wanted to insure myself."

'Coming out of the rain'

For his wife, he bought catastrophic coverage. It wasn't cheap -- about $200 a month -- and it came with a whopping $25,000 deductible. This meant they both avoided doctors as much as they could.

So on those occasions when his sinuses swelled shut and he couldn't sleep for days at a time, he felt helpless.

"I had no reasonable means to get help," Ruscoe remembered.

He's a liquidator, and his wife joined him in the business. They buy abandoned storage unit items and goods leftover from estate sales and then resell them. It's a physical job that keeps him lifting objects, transporting boxes and jumping into and out of big moving trucks.

Ruscoe has gotten some nasty gashes along the way, but he had no problem taping those up himself. But when he tumbled out of a truck, a year or so before Obamacare emerged, being uninsured terrified him.

He remembers the moment his foot got stuck and he began to fall. He says he felt like Wile E. Coyote, of Looney Tunes fame, hanging in the air right before gravity kicked in. The thought bubble above his head would have read, "This is really going to suck," he said.

When he hit the ground, he couldn't breathe. After he caught his breath and began to wiggle his fingers and toes, he was stunned to be in one piece. He got bruised up but knew it could have been a lot worse. Had he landed differently, medical expenses might have ruined him.

So Ruscoe took notice when the Affordable Care Act began making news.

"I thought it was a good idea, even though I'm a conservative," he said. "It's a social program, but a lot of social programs are for the good. And this is one of them."

The moment the website went live, he was online, ready to sign up. It had been several years since he'd been insured, and he remembers the relief that came over him.

"It's the feeling of coming out of the rain, if you will," he said. "You can do all you can to get healthy. You try to be safe. But there's a certain amount of fate that's just out there."

No guarantees

The value of coverage was immediate. During wellness checks, something he and his wife had ditched in their time without insurance, she learned that she had high cholesterol. And though he'd worked hard to lose a significant amount of weight, he'd plateaued. Once a doctor offered nutritional counseling, he shed the last 40 pounds.

Irrespective of political persuasion, he says, having access to services that keep people healthy makes sense. He couldn't understand friends who didn't take advantage of the health care opportunity.

"It's made to be affordable for everyone. Why wouldn't you?" he asked.

Come February 1, he'll be paying about $338 a month for himself and his wife. Without Obamacare, he says, the same plan would cost them $1,150 a month -- or close to $14,000 a year. Rates like that would mean no more insurance for them.

They're not getting any younger, and Ruscoe knows that there are no guarantees when it comes to health. He thinks of his grandmother who died of colon cancer and talks about the importance of preventative medicine, including access to procedures like colonoscopy.

"I'll be bellying up to get my first one this year," he said.

Without insurance, he's not sure that would be possible for him and his wife.

Ruscoe doesn't pretend to know how cost-effective Obamacare is and assumes it requires tweaking. But he hopes the Trump administration will recognize and hold onto what's worked.

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He feels like it's his "civic duty" to speak up, he says. It's important to remind people that slashes to coverage may lead to "a segment of the population that'll be left swinging in the breeze."

His views will surprise some of his friends, he suspects.

"They'll freak out that I was strongly considering voting for Clinton," he said. "But I think she would have been very compassionate, and you need that."

Ruscoe's now banking on Trump showing some compassion, too.