MOUNTAIN HOME -- 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 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 fiance, who works in housekeeping. Their son started in 2013 repairing medical equipment. He was introduced to his wife by two nurses there, one who is now his mother-in-law, and Beverly Green, now an aunt through marriage.
"Without our hospital, I'd probably be working at McDonald's," said 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."
That's not surprising in Baxter County. 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 Donald Trump, the fight over the Patient Protection and Affordable Care Act is about both lives and livelihoods, access to care and to jobs.
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.
In the meantime, Trump has moved to scrap subsidies to insurance companies to 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. 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 effect is magnified. Health care has long been an economic bedrock in Baxter County. 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 1 in 9 jobs nationwide, but 1 in 4 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 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.
The financial effect of the Affordable Care Act on the hospital has been mixed. The Medicaid expansion in Arkansas allowed residents earning 138 percent of the federal poverty level -- $16,643 for an individual or $33,948 for a family of four -- to buy private insurance paid for primarily by the federal government. That extended health care access to people who had never been insured and shrank charity-case costs.
But it also reduced Medicare reimbursements, which cover the elderly. This trade-off left many hospitals ahead, but not Baxter Regional, which has an unusually large share of Medicare patients -- 67 percent compared with a national average of 40 percent.
The added $4 million in Medicaid payments did not make up for the $12 million lost through Medicare. As Peterson points out, however, the Republican proposals to remake the law would have decreased Medicaid money without restoring any Medicare cuts.
Arkansas would be particularly hard hit because it is among a handful of states with provisions that automatically end expanded Medicaid benefits if federal funding is reduced.
The result would be fewer insured patients and a lot more debt.
A repeal now, Peterson said, would be calamitous.
Whatever the criticisms, the dozens of employees interviewed at Baxter Regional and elsewhere all expressed thanks that more people had insurance.
The law has brought insurance to more than 360,000 people in Arkansas, and it now covers 61 percent of children in the state's small towns and rural areas.
Dr. Lucas Bradley, a neurosurgeon who voted for Trump and credits him with shaking up inside-the-Beltway cronyism, said the health care law had "benefited hospitals, patients and providers in the state of Arkansas."
"There were lots of parts in that bill that were done right, parts that were necessary," Bradley said. There were significant shortcomings, too, he said, but he called them fixable. However, he added, bitter partisanship has made the law a lasting target.
A Section on 10/17/2017
Print Headline: Hospital braces for health cuts