NEWBURGH, Maine — At first sight, farmer Everett Ottinger, a trim, active man who revels in the hard physical labor that is a basic fact of life at Nettie Fox Farm in Newburgh, appears to be in the picture of health.

That’s what he thought, too — at least until the summer of 2015, when Ottinger, now 30, began to be troubled by mysterious symptoms. His energy was low, he was always thirsty, always had to pee, and he lost a scary amount of weight despite being hungry all the time. He attributed some of that to the hustle of the growing season, but after going to a family wedding and hearing from relatives who hadn’t seen him in a while that he looked scarily gaunt, he decided to go to a walk-in clinic in Brewer.

The doctor there did some blood tests, and by the time Ottinger drove home, there was a message on his answering machine.

“Turn around and get back here — you’re dangerously diabetic,” the farmer recalled hearing.

And just like that, his life changed.

“I’d always been healthy. I’d never needed more than ibuprofen in my whole life. I was never really in the [health care] system at all, and now I’m tethered to it,” he said.

Ottinger, 30, who lives with his wife, Molly Crouse, and their 2-week-old daughter in an old farmhouse on their 30-acre spread, has to check his blood sugar before each meal. He was diagnosed with latent autoimmune diabetes in adults, a slowly progressing variation of Type 1 diabetes, and is completely reliant on the drug insulin.

That is why he is among the Maine farmers loudly speaking out in favor of the endangered Affordable Care Act. It has helped his family afford health insurance and his life-saving medication throughout his health ordeal.

A Bangor Daily News query about what Maine farmers think about the Affordable Care Act, shared on two farmers’ forums on Facebook, only resulted in responses from farmers — like Ottinger — who have benefited from and who like the law.

“I would literally die without insulin,” Ottinger said. “I really, really need help paying for drugs. I have to see an endocrinologist. I have to see my primary care physician, and I never even had a primary care physician before. We’re self-employed. We’re small business owners. The reason we didn’t have insurance before the [Affordable Care Act] was that we couldn’t afford it. I know it’s a controversial law, and there’s lots of people it doesn’t work for. But it saved my life, and it has kept our business afloat.”

Changes coming

The 2010 Affordable Care Act, also known as Obamacare, was former President Barack Obama’s health care overhaul and signature domestic achievement. But it’s set squarely in the sights of the Republican-led Congress and President Donald Trump.

The new president has vowed to repeal and replace the law, and he already has taken steps toward unwinding some of its elements, though it’s unclear how it will actually happen. That means that Mainers such as Ottinger, a self-employed farmer who depends on both government subsidies and the Affordable Care Act’s rule that insurance agencies cannot refuse to cover treatment for a pre-existing condition, are living in uncertainty.

“I’m not going to wake up and not be diabetic,” the farmer said. “My costs are only going to increase. If we lose our insurance, we can’t pay for medical costs. We can’t pay for a private insurance policy. … It’s pretty important to us that if it’s repealed, it’s replaced — don’t throw the baby out with the bathwater.”

Members of Maine’s congressional delegation so far have agreed with the final part of Ottinger’s plea. U.S. Sen. Susan Collins, a Republican, last week joined a Louisiana senator to unveil new legislation aimed at replacing the Affordable Care Act. The Patient Freedom Act of 2017 is intended to increase Americans’ access to affordable health care by giving states more flexibility in regulating health insurance.

Meanwhile, U.S. Rep. Bruce Poliquin, a Republican who represents the 2nd District where Ottinger lives, has called the Affordable Care Act “failing” legislation and decried its rising rates for monthly premiums, co-pays and deductibles. He indicated that he supports repeal of the law if its replacement includes coverage for pre-existing health conditions and allowing people 26 years old and younger to stay on their parents’ plans.

In contrast, independent U.S. Sen. Angus King and 1st District U.S. Rep. Chellie Pingree, a Democrat, have said that a rushed repeal of the Affordable Care Act would have disastrous consequences for millions of Americans and tens of thousands of Mainers.

Earlier this month, King said in a media release that he urged his “colleagues to put aside politics and focus on instituting meaningful improvements to the Affordable Care Act or, at the very least, to put forward a credible replacement plan before moving to repeal the law.”

Pingree, who has worked as an organic farmer on North Haven, said in a telephone interview last week that Maine’s many small business owners, including farmers, are among those who could suffer if the law is repealed. Before the law was passed, many Maine farmers with health problems but without good insurance ended up saddled with significant debt when they did seek medical help, Pingree said. And other farmers who had catastrophic health insurance with very high deductibles likely did not go to the doctor on a regular basis.

“Farmers in Maine are generally on the individual health insurance market,” she said. “Prior to the [Affordable Care Act], it was very expensive and difficult to get health insurance. And farming is a profession that’s really hard on your body.”

Affordable Care Act benefits to small farmers

That farming can be physically strenuous is something that Ben Whatley of Whatley Farm in Topsham knows very well. He and his family cultivate fruit trees, herbs and about 5 acres of vegetables on their certified organic farm near the Cathance River.

“We keep ourselves healthy, but it’s a hazardous occupation. I have to have something in case of accidents,” he said. “Lyme disease is the only thing, besides accidents, that I’m really worried about. I’m out there with ticks all the time.”

The 32-year-old said he didn’t have health insurance for a number of years in his 20s, but when the Affordable Care Act subsidies became available, he looked into it. As a new farmer making just $12,000 per year, his monthly premium was about $25, he said. As his income has grown, so has the monthly premium, and now he pays about $90 per month.

“I haven’t figured out what I would do if the subsidy goes away,” Whatley said.

Neither has Bill Pleucker, who grows organic vegetables at Hatchet Cove Farm in Warren. He and his wife, Reba Richardson, had high-deductible catastrophic health insurance before the enactment of the Affordable Care Act.

“When the [Affordable Care Act] came around, we got on it immediately,” he said. “We desperately need the [Affordable Care Act]. Without it, farming and owning a small business becomes much more difficult and much less viable economically. Especially in a state like Maine, where there are so many self-employed folks, we need it.”

That became especially clear in 2015, when Pleucker fell and tore a ligament in his knee. The injury required two surgeries, and without health insurance, would have cost more than $100,000. That’s an impossible sum for the farmer to imagine paying. With government subsidies, the family pays nearly $400 per month in premiums. But without the subsidies, Pleucker estimates they’d be paying about $1,000 per month.

“I don’t know how we would increase our income by that much,” he said. “Maybe if we both left the farm, we could. But when you’re your own boss so long, it’s hard to go back.”

For Stacy Brenner of Broadturn Farm in Scarborough, the Affordable Care Act also has functioned as a tool that allows her family to keep growing its diversified farm business.

Last summer, the farm hired 23 employees, who are paid an average of $14 per hour, she said. Offering workers a living wage is a source of pride to Brenner, but the farm cannot afford to offer benefits such as health insurance to its seasonal employees.

“Maine is a state of small businesses,” she said. “If we want to encourage and promote the development of small businesses, we need to make sure there’s an option that’s not employer-based. It allows there to be opportunity for freelance work and consulting, it allows the creative economy and the local food movement to grow.”

She and other farmers said that they’ve been contacting their elected officials — especially Collins and Poliquin — to make the case to save the Affordable Care Act.

“I have Collins on speed dial on my phone,” Richardson said. “I call her twice a day these days.”

Ottinger, too, has reached out, and so far has only received “thanks for your comment” auto responses, he said.

Brenner did receive a direct reply from one of Collins’ staffers, but when asked if she felt that the Republican politician had heard her concerns, she didn’t have a quick response.

“I don’t know what to expect, in terms of what it means to be heard by our politicians. I don’t know what that looks like,” she said.

For Ottinger, the idea of health insurance and health care has moved from theoretical arguments to the frighteningly real. He understands that the political maelstrom surrounding the Affordable Care Act can be complicated, noisy and even emotional. But as he sat at his dining room table and pricked his finger to check his blood sugar before having a midday cup of coffee, he had something else to say, about him, and diabetes, and his family’s hope to keep on growing vegetables for Mainers for many years to come.

“I’m not a welfare leech. This is just a super unfortunate thing that happened. I value Maine’s independence and stoicism, but I think Mainers are also good at looking out for one another,” he said. “Without the [Affordable Care Act], we would definitely have to quit farming to get insurance through a corporate employer. And farming is more than our livelihood. This is our lives. It really makes us complete. If we were forced to quit farming, it would be a huge blow.”