Oran McCall,5, waits with his mother to register at dawn, after sleeping in their cars, to see a doctor at the Remote Area Medical (RAM) mobile clinic on June 10, 2017 in Olean, New York. Republicans want more of this.

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There will be a lot of pain to go around if Trumpcare passes and is signed into law, but some of the worst and most widespread pain will hit the Medicaid population. Even within that group, there will be relatively bigger losers, and children will be among them. Particularly, as a Los Angeles Times analysis of Medicaid enrollment data highlights, rural children.

[In 780] mostly rural counties across the country—the vast majority of which went for Trump—more than half the children rely for coverage on Medicaid and the related Children’s Health Insurance Program, or CHIP, according to a Times analysis of county voting data, census data and Medicaid enrollment data.

That is stoking rising alarm among parents, pediatricians and other medical providers in West Virginia and other largely rural states, including Arkansas, Tennessee, New Mexico and Maine.

“There is just no way to cut Medicaid on the scale that they are talking about and avoid hitting kids,” said Dr. Traci Acklin, who grew up in Fayette County and now runs the only pediatrician’s practice in Montgomery, out of the first floor of a community hospital founded a century ago to care for sick miners.

“Without the health insurance, kids aren’t going to get the immunizations and the checkups. There are going to be more lost days of school. More trips to the emergency room…. It would be food or healthcare for a lot of these families.”

That would be a new low for the U.S. It’s bad enough that the majority of low-income parents of these children had to make those decisions for their own health care before Obamacare’s Medicaid expansion. Adults in 19 states which refused that expansion still have to make those decisions for their own care. But at least their kids could be covered—that’s been true under Medicaid for decades.

According to the Times’ analysis, 622 of the 780 counties where a majority of children are on Medicaid or CHIP have fewer than 50,000 people. Those are the places where the hospitals are large employers, hospitals that could have to shut down when there isn’t Medicaid to pay for the treatment they provide. If Republicans want to really destroy their own voters, the people they were elected to represent, they couldn’t have found a more effective way.

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Rural kids, communities would lose the most under Trumpcare’s Medicaid cuts