Deep in Trump Country, a Big Stake in Health Care – Part One

Mountain Home, a small town in Arkansas, a state that overwhelmingly voted for Donald Trump in the last election, finds itself in the uncomfortable situation of being heavily dependent on the Affordable Care Act both for its health care services and for local employment. If the President’s current proposals were  carried out, half the town would be out of work and many would lose their health insurance.

Because of the article’s length, we are presenting it in three parts.

health-effect-slide-US1K-jumboBaxter Regional Medical Center is the largest employer in Baxter County, with a payroll of roughly 1,600.

MOUNTAIN HOME, Ark. — Marjorie Swanson was the first in the family to get a job at Baxter Regional Medical Center after moving to this rural Ozark town from Chicago’s South Side in 1995.

A year later, her husband was hired by the maintenance department. Six months ago, their daughter snagged a job as a pharmacy technician and shares the night shift with her fiancé, who works in housekeeping. Their son started in 2013 as a biomedical technician, repairing medical equipment. He was introduced to his wife by two nurses there: one who is now his mother-in-law and Beverly Green, an aunt through marriage.

“Without our hospital, I’d probably be working at McDonald’s,” said Ms. Green, who was born at the medical center 47 years ago and has worked there for the past 27, first as a nursing assistant, and now as a manager. “Almost everyone has someone related here.”

Samuel Bradley, 7, on the white River near his family’s property in Arkansas. His father, Dr Lucas Bradley, a neurosurgeon, took a job in the area because he and his wife wished to raise their family in a small town.

That’s not surprising in Baxter County, in a part of northern Arkansas known for two dragon-shaped fishing lakes filled with largemouth bass, walleye and bream. The hospital is the single largest employer, with 1,600 people paid to mop floors and code insurance forms, stitch wounds and perform open-heart surgery.

“We are the economic anchor of the community,” said Ron Peterson, Baxter Regional’s president and chief executive. “When we downsize, the whole community downsizes.”

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, 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.

“I’m optimistic about the economy, but I’m not optimistic about this health care reform,” Marjorie Swanson said. Like many of her co-workers and neighbors, she dislikes parts of the law that President Barack Obama championed. But she also knows that undoing it now would reduce both the number of insured patients and the government payments that keep the hospital afloat.

One of 31 states (plus the District of Columbia) that chose to extend Medicaid coverage, Arkansas got extra money to cover more low-income residents. Its adult uninsured rate dropped 12.3 percentage points, more than nearly every other state.

Losing that Medicaid money now might not put Baxter Regional out of business, but it could compel the independent, nonprofit hospital to merge with a larger system and cut back its services and work force. And that could be as devastating as slashing jobs at a steel plant in a factory town.

Gathered in a conference room at the hospital between shifts, many in the extended Swanson clan, dressed in a rainbow of blue, red and maroon scrubs, said the law needed to be fixed, not scrapped. And they primarily blamed a corrupt Washington establishment — not Mr. Trump — for failing to do so.

“It’d be like getting a new job as a manager here and every single person is against you,” Ms. Green said of Mr. Trump. She grew up in a family that leaned Democratic, and she supported Bill Clinton, then the state’s governor, for president in 1992, but said she didn’t trust Hillary Clinton.

Still, she is anxious about how Republican-led changes in health care could affect her job. “Probably we’d have to move,” said Ms. Green, whose husband is a firefighter. “But where to go? My whole family’s here. There’s no one who comes for a holiday from somewhere else.”

Ms. Swanson, 52, nodded. “We’d have difficulty getting a job with insurance,” she said. “And where would we get our care?”

Hospitals in rural areas have long struggled financially, but over the past decade the rate of closings has grown steadily. As young people gravitate to urban centers for college and employment, populations have dwindled, and those left behind are often poorer, sicker and less apt to have health insurance.

A patient being wheeled to a medical evacuation helicopter at Baxter Regional Medical Center in Mountain Home, Ark. The center offers an uncommon range of services for a rural acute-care hospital.

Baxter Regional, serving a county seat that is a retirement destination, is in a stronger position than most of the nation’s 2,500 rural acute-care hospitals. It offers neurosurgery and an emergency cardiac catheterization lab, the state’s first 3-D mammograms and magnetic resonance imaging. Still, it exists on a financial knife edge even as it helps prop up the local economy. The average operating margin began dipping below the break-even point in 2006 and has hovered near there since.

To be continued

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