In Pennsylvania, 625,000 people enrolled in the expanded Medicaid program. Close to 300,000 came from rural areas, said Andy Carter, president of the Hospital and Health System Association of Pennsylvania. As of October, about 42,700 of Fayette’s residents had Medicaid, according to state data, an increase of about 8 percent from 39,460 in June 2015. (Pennsylvania‘s Medicaid expansion took effect in January of that year.) That’s close to one-third of the county’s population.

Despite that, Highlands CFO John S. Andursky said he barely noticed the increase — the threat of closure is a “daily concern,” he said. “It seems like you’re taking two steps forward, three steps back ... It’s not like I can look to five years out — because I have to worry about tomorrow. I can’t worry about next year.”


That pessimism can be heard throughout this town of about 7,600 residents. While the law was described as historic, many here do not perceive that it helped them. Like many other states, Pennsylvania re-branded their expanded offering of federal insurance programs for the poor, fearing that “Medicaid” which is also often referred to as “Medical Assistance” would be off-putting; now it is called “Healthy PA.”

Bryan McMullin, a 47-year-old who works in Connellsville’s river-rafting business, got coverage last year but said good health care remains hard to come by. “In this area, nothing’s changed in 40 years, no matter who is president,” he explained from a bar stool at a pub near the now-vacant glass factory.

Daniel Martin, a 28-year-old Highlands patient who also works in the rafting trade said he uses his new coverage for his monthly blood medication. A Trump voter, he hadn’t realized that coverage now could be in jeopardy.

And small towns like this tend to be far sicker than the norm. In Fayette, more than 1 in 10 people is estimated to have diabetes. Out of 67 counties in the state, Fayette ranks 66th for health outcomes and more than a third of its residents are obese. It’s tied with northern Potter County for the second-highest teen birth rate in the state. Between 2014 and 2015, the county saw about 31 people overdose for every 100,000, according to an analysis by the federal Drug Enforcement Agency.

Plus, the hospital is Connellsville’s second-largest single employer, after the school district. It contributes an estimated $15 million to the local economy, Andursky said. That’s in a town where unemployment’s already at 7.6 percent — up from last year and higher than the state and national averages.

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