A Georgetown University study shows that rural Nevada has had the biggest drop in uninsured children since 2008, from 21 percent to 7 percent.  A big reason for that is Medicaid expansion, which provides coverage for 37 percent of rural Nevada kids.  That program could face severe cuts.

"Nevada's highlighted in the report," Denise Tanata, Executive Director of Children's Advocacy Alliance said. "Our small towns and counties are going to be some of the hardest hit in the entire country."

Senators Dean Heller and Catherine Cortez Masto say they want a bill that keeps Nevada's Medicaid expansion program in place.  That could make a huge difference for people in rural counties.

"It's difficult in our rural communities just to even get some of our health care providers there, and then geographically, they're challenged," Cortez Masto, D-Nevada said. "If they can't have access to health care there in their communities, they have to drive long distances."

"To me, the most important thing is the Medicaid expansion portion of it, and to make sure that Nevadans continue to have insurance," Heller, R-Nevada said.

Cortez Masto says small town residents have better health coverage and access because of the ACA.

"Our rural hospitals are able to provide more programming and they've actually hired more people in our hospitals to address the need for many people who have insurance for the first time," Cortez Masto said.

The American Health Care Act passed the House of Representatives, and is being reworked by the Senate.  Many Democrats and Republicans say they want a bill that allows people to keep their kids on their insurance until they are 26 years old, and protects people with pre-existing conditions.  Katie Coombs has a heart condition, and she says removing that piece would leave her out in the cold, along with millions of other Americans.

"It means higher premiums all the time, higher deductibles, and ultimately probably a lack of coverage for people who can't afford to keep up with that," Coombs said.

Coombs worries that Congress is making its decision without enough input from the patients who are affected most.

"We're real people out here and I think that's the problem," Coombs said. "They're looking at charts and graphs."

Dr. Andy Pasternak says Obamacare needs to get fixed, but not gutted.  He says the ACA has allowed many more people to get preventive care and screenings for things like colon and cervical cancer.

"We're able to pick up things before they turn into serious cancers, before they turn into deadly cancers," Pasternak, Founder of Silver Sage Center and Family Medicine said. "So that, in and of itself, is probably one of the biggest impacts."

Cortez Masto says congress needs to work in a bipartisan way that benefits Americans to the fullest.

"Health care in this country should be affordable and people should be able to access it and nobody should die or go bankrupt because they can't afford health care, and that's what this fight should be," Cortez Masto said.