Nineteen years ago, after medical school at Columbia University; a stint at Montefiore Medical Center, in the Bronx; and a period running homeless shelters in Times Square; Karen Kinsell moved to Fort Gaines, a tiny town in southwest Georgia, on the Alabama line. Fort Gaines is in Clay County, which is consistently ranked among the poorest of the hundred and fifty-nine counties in the state. It currently ranks third-to-last in "health outcomes," according to the Robert Wood Johnson Foundation, up from dead last. Clay County's only hospital closed its doors in 1983, long before Kinsell, who is now in her sixties, arrived and became its only doctor. "It's a bad place to live," Kinsell said recently by phone, between seeing patients, "which is why I moved here. I was looking for a place that needed me."
Kinsell runs Clay County Medical Center, a facility with four exam rooms built out of a former Tastee-Freez. It's a private practice, but she is a full-time volunteer. There is a receptionist and two other full-time staff members; they see "around thirty to thirty-five patients a day," Kinsell said. Monty Veazey, the president of the Georgia Alliance of Community Hospitals, told me that "Kinsellcare" is the only health care that's had a meaningful and positive effect here. "She's going bankrupt treating everyone that comes in," he said. "Most have no money, no Internet access, no other basic care. Many don't have insurance. How much longer can she do that? I don't know. But she's their only hope."
On Tuesday, shortly before Senator Mitch McConnell announced a delay in the vote for the Senate Republicans' health-care reform bill, Kinsell spoke by phone about the effects of Obamacare, the prospect of Trumpcare, and the plight of sick people in southwest Georgia. Her account has been edited and condensed.