So for residents of the nearly all-white county, who overwhelmingly voted for President Trump, the fight over the Affordable Care Act is about both lives and livelihoods, access to care and to jobs. And the cloud that remains over the law’s future is unsettling.
Even after the latest Senate effort to overturn the bill collapsed last month, Republicans insisted that the failure was not the final word on the matter for this Congress. “At some point there will be a repeal and replace,” Mr. Trump declared. In the meantime, he has moved to scrap subsidies to insurance companies that help cover low-income people and signed an executive order permitting policies exempt from some of the act’s coverage rules — actions that supporters of the law say will gut it.
Whatever happens, the economy of every state will be affected. Across the country, the health care industry has become a ceaseless job producer — for doctors, nurses, radiologists, paramedics, medical technicians, administrators and health care aides. Funding that began flowing in 2012 as a result of the Affordable Care Act created at least a half-million jobs, according to an analysis by Goldman Sachs.
In many rural areas, where economies are smaller and less diversified, the impact is magnified. Health care has long been an economic bedrock in Baxter County, with a population of 41,000. But its significance has grown since the Affordable Care Act passed. The hospital alone has added 221 employees, a 16 percent increase, since 2011. The health sector accounts for one in nine jobs nationwide, but one in four here — roughly equal to the share employed by the county’s manufacturers and retailers combined.
