A stroll into Hot Springs' pharmacy is to amble in the past. Wood framed cabinets still line the central aisle, and the original black and white tile are in place. Conversations haven't changed much. How will the high school football team do this year? What are various people fixing for the bake sale at the local Volunteer Fire Department, and so on.
One topic which has been at the fore of everyone's thinking is health care. It's not just Trump's threats to gut Obamacare which has people talking. The county's only hospital is being ground into the dirt by the board of directors, and many in this county of under 5,000 don't see the hospital being there much longer.
Bath County leaned heavily to Trump with 69% of voters sending him to The White House and just a shade over 26% wanting Hillary Clinton. Now, many of those who supported Trump are starting to have buyer's remorse, and residents are increasingly uneasy.
Hayleigh Moore, not her real name, was the first among her family to get a job at Bath County Hospital. Twelve months later, her husband found work in the maintenance department.
A year ago their daughter hooked a career as a pharmacy technician and shared the night shift with her fiance who works in environmental services.
"If the hospital leaves, I don't know what our family will do for work," says Moore. "Others are in the same boat as nearly everyone is related to someone."
That doesn't surprise anyone in Bath County. In a part of western Virginia known for The Homestead Hotel, the hospital is the second largest private employer.
"The hospital is a small economic engine inside the community," says one resident. "If they close the whole community suffers."
For residents of the almost all-white county who voted for Trump, the struggle over ACA is about lives and access to care. The cloud hanging over the law's future is unsettling to those not naive enough to fall for Trump's bright sales line: "I will make healthcare better than anyone, and everyone will be covered."
After the Senate effort to overturn ACA fell in September, Republicans insisted the failure would not be the final word.
Trump has moved to trash subsidies to insurance companies that help low-income people in Bath County and has signed an Executive Order granting exemptions from ACA; actions that experts say will gut health care for rural communities like Hot Springs.
Bath County and Virginia aren't alone. The economy of every state will be impacted. America's health care industry has become an endless producer of jobs for physicians, nurses, radiologists, medical technicians administrators, and aides. Funding which began in 2012 because of the ACA created over a half-million jobs according to a survey by Goldman Sachs.
In financially strapped regions like Bath County where the economy is smaller and not as diversified, the impact will be magnified.
"I'm optimistic about the economy," says Moore. "But I'm not optimistic about the hospital's future." As with many of her neighbors, she doesn't like parts of the law that Obama championed. She knows though that undoing it now would reduce both the number of insured residents and the government payments that help keep the hospital alive.
Losing government dollars now could put the hospital out of business or force it to merge with a more extensive system resulting in reduced services and a smaller workforce. With 110 full-time equivalents, roughly equal to 140 employees, the economic impact could be devastating.
Emails from many of the employees say the law — and the board of directors — need to be fixed. While Trump gets his share, county residents also blame an inept board, more interested in profits than people, for the precarious standing of the facility and jobs.
Asked about how she feels with the Republican-led changes in health care, she says, "We'd have to move. But where to go? My whole family is here."
Hospitals in rural areas like Bath have struggled financially for a long time. A combination of a board of directors who don't understand the business side of healthcare and possible government cutbacks could shutter the only facility for twenty miles.
The county's young people move to urban centers for college and jobs, and the population shrinks. Those left behind are poorer, sicker and less likely to have health coverage.
Soon, health coverage won't be a factor if the hospital closes its doors.
Jerry Nelson spends much of his time poking Trump’s meth-addled, uneducated fans with a pointy stick and is currently writing a book of muskrat recipes as well as a scrapbook of his favorite death threats. His life’s aspiration is to rule the world with an iron fist, or find that sock he’s been looking for. Feel free to email him at jandrewnelson2@gmail.com if you have any questions or comments — or join the million (seriously) or so who follow him on Twitter @Journey_America.Never far from his Marlboro’s and coffee, Jerry is always interested in discussing future writing opportunities.