That opinion hasn’t changed much. Randy Lennartz, the hospital’s chief executive, told me that while Obamacare isn’t perfect, it did result in a wave of people seeking medical care who had previously ignored preventive-care visits. Those numbers have tailed off, but Lennartz said he believes that’s largely because their conditions were successfully treated.

The downside of Obamacare, he said, was that most people who signed up through the insurance exchanges chose the cheapest plans available, plans that came with deductibles in the $5,000-to-$10,000 range that few can afford. The median household income in Highland County is just under $40,000, according to census figures.

As in other states, insurance premiums rose under Obamacare, and choices continued to shrink. Just a few weeks ago, Anthem Blue Cross and Blue Shield announced it will not sell policies in Ohio in the Obamacare marketplace in 2018. On the heels of that announcement, Premier Health Plan said it is also pulling out, leaving as many as 20 Ohio counties with no health insurer on the state exchange.