MARTINSBURG, W.Va. — Diane Hughes took the microphone, looked down at the paper in front of her and said, “I’m nervous and I don’t like politics, but here it goes.”

Hughes was among the West Virginia residents gathered at the Robert C. Byrd Health Science Center here on Thursday for a town hall meeting on the Republican plan to overhaul the 2010 health care law. The meeting’s organizers had asked her to share her story, and she admitted she was initially reluctant to do so.

“As the physical injury healed, those little pills’ purpose changed,” Hughes said, explaining her addiction to pain medication after fracturing her hip. She credited the health care law with allowing her to participate in a behavioral health program that has helped her recover.

The law’s effect on mental health and combating opioid addictions was a top concern for attendees, who were trying to learn more about how the House GOP plan would affect their state. 

The Republican plan, which is scheduled for a House floor vote on Thursday, would eliminate a requirement relating to mental health and substance abuse services. Plans offered through the 2010 law’s Medicaid expansion were required to provide those services.

West Virginia Sen. Joe Manchin III, who participated in the town hall, explained to one constituent that mental health coverage would be adversely affected by the GOP bill.

“We’re very much concerned about that and that’s why we’re opposed to that,” the Democratic lawmaker said. 

[Manchin: Only Trump Can Stop Obamacare Repeal]

The Mountain State experienced a 17 percent increase in rates of opioid deaths from 2014 to 2015. In the latter year, West Virginia had the highest rate of deaths due to overdose in the country, according to the Centers for Disease Control and Prevention.

“Almost every day we’re reading about somebody that I went to school with, or you went to school with, that we’re burying because of it,” Hughes said. Many in the audience nodded in agreement.

“We finally took a step in the right direction,” she said, referring to the 2010 law, also known as the Affordable Care Act. “And now it’s looking like the rug’s going to be pulled out from under us again, and we haven’t even gotten a grip on it yet.”

A cohort of doctors from Hughes’ health facility, the Shenandoah Community Health Center, wore their white coats to the meeting. They had closed their office so they could attend and share their concerns with Manchin.

One of them, Dawn Jones, stood up and pointed out that the center is the largest health care provider in the eastern panhandle, and 30 percent of their patients were uninsured before the 2010 law. 

If it is repealed without a “suitable replacement,” she said, “West Virginians will be in dire straits.”

Roughly 175,000 West Virginians enrolled in the Medicaid expansion through the 2010 law, according to the advocacy group West Virginians for Affordable Health Care. The GOP plan would roll back that expansion, ending enrollment after 2019. Some conservatives want to freeze enrollment as soon as 2018.

[Road to House GOP Health Plan Passage Still Uncertain]

“You’re in trouble,” Kathleen Stoll of West Virginians for Affordable Health Care told the crowd.

Many at the meeting said they were attempting to learn more about how the plan would affect their lives, as well as where Manchin stood on the issue.

“I think part of it is that this rollout of the Republican bill has been so fast that Sen. Manchin, along with probably everybody else, is just trying to figure out what in the world to do with this,” said Grant Prillaman of Shepherdstown.

“What’s there? What does it mean? What kinds of responses make sense?” the 65 year-old high school Spanish teacher asked. 

Prillaman, a Democrat, said two of his three adult children benefit from the state’s Medicaid expansion.

“They would be in very dire straits if that goes away,” he said.

Bob Snodgrass, a 77-year-old Illinois native who moved to West Virginia in 2013, said he was unsure how he would be affected, since he’s currently on Medicare. Snodgrass is a registered Republican, but said he was frustrated with GOP lawmakers’ actions on health care.

“I’m still trying to figure out what they’re doing,” he said. “I’m aggravated at them because they had eight years to put their plan in place, and they were waiting until they get a Republican president before they even start trying to figure out what the hell they want to do.”

A number of attendees spoke in favor of a single-payer, or government-funded, health care system. Manchin said he was open to exploring that option, and was interested in learning more about the Canadian health care system.

[CBO: Lower Deficit, More Uninsured Under House Health Plan]

Travis Bishop, a 47-year-old veteran, said there should have been more discussion about how the existing health care law has hurt West Virginians.

Bishop’s son has a heart condition, and had three open-heart surgeries before he was three years old. Bishop’s family is enrolled in a program through the law’s individual exchange, since he is self-employed. He said his family’s premiums have doubled since the law took affect.

“I make $42,000 a year. Half of my salary goes toward health care,” he said. “That’s not affordable.”

Bishop is a Gulf War veteran, a registered Republican, and an ardent supporter of President Donald Trump. He said he has not looked into how the GOP plan would affect his family. 

According to the Congressional Budget Office, the Republican bill would lead to an increase in premiums in the short term, but those costs would start to decrease after 2020.

The bill still faces an uncertain future in Congress, where House Republicans are addressing concerns from conservatives and moderates.