Much has been written about the impact that Obamacare has on the healthcare consumer, focusing specifically on the effects of lost coverage, lost doctors, premium hikes, mandate penalties, and reduction in choice. These effects have already been felt and are predicted to get worse in 2015. But Obamacare is having other, more systemic effects on the economy that are just now being felt. One of these, covered here in the USA Today, is the decimation of America’s rural hospital network, which acts as a life saving first response network for heart attacks, strokes, and other medical conditions that require immediate intervention for long term survival.

One of the ways that Obamacare has negatively impacted these hospitals is in imposing additional and costly record keeping requirements that have placed a financial strain on these hospitals, which typically hang on to financial solvency by a shoestring to begin with. Another and more significant way, however, is through the act’s “readmission penalties,” under which hospitals are penalized for readmitting too many Medicare patients within a 30 day window. These penalties disproportionately hit rural hospitals, which serve poorer and less well educated healthcare consumers, and consumers who are less likely to have a regular primary care physician. As a result, through no fault of their own, they are more likely to see repeat patients, especially those who are noncompliant with discharge instructions for outpatient followup care. The readmission penalties were intended to improve quality of care, but instead they end up systematically financially crippling rural hospitals.

These rural hospital closures, which have become endemic since Obamacare passed, are about to get worse. The readmission penalty will be raised in 2015 from 1% of Medicare reimbursements to 3% of Medicare reimbursements. And these closures will have trickle down effects on the economy, as rural hospitals are often the largest employer in many small towns, and often support several other businesses with their presence. But even more than the economic effects, their closures will have real effects on the health and safety of Americans.

There’s a “golden hour” after heart attacks, trauma and stroke in which treatment is needed to prevent loss of heart muscle and brain tissue, says Janis Orlowski, chief medical officer for the Association of American Medical Colleges.

With just two ambulances, which are often tied up making the average 90-mile round trip to the nearest hospital, “We’re pretty much shot around here with the golden hour,” says Ed Lynch, Stewart County’s director of emergency medical services.

For all the hysteria raised by Democrats about the negative impacts repealing Obamacare would allegedly have, the reality is that for rural Americans in particular, the repeal of Obamacare is necessary to save lives. And even if King v. Burwell undercuts the individual mandate or Congress passes cosmetic fixes to the medical device tax or other bad portions of the law, it will be almost impossible to disentangle all the other crippling financial effects absent a full repeal.

Congressional Republicans should insist on nothing less.