In this Thursday, May 18, 2017 photo, Carol Berg talks about the challenges she and her neighbors in White Sulphur Springs, Mont., face with affording health care. Berg works as a hairdresser and upholsterer. She and her husband recently qualified for Montana's Medicaid expansion program. Health care is weighed heavy on her mind when she recently cast her ballot for the special election to fill the state's sole U.S. House seat. As a protest, she said, she voted for the Libertarian candidate. (AP Photo/Bobby Caina Calvan)

In this Thursday, May 18, 2017 photo, Carol Berg talks about the challenges she and her neighbors in White Sulphur Springs, Mont., face with affording health care. Berg works as a hairdresser and upholsterer. She and her husband recently qualified for Montana's Medicaid expansion program. Health care is weighed heavy on her mind when she recently cast her ballot for the special election to fill the state's sole U.S. House seat. As a protest, she said, she voted for the Libertarian candidate. (AP Photo/Bobby Caina Calvan)

WHITE SULPHUR SPRINGS, Mont. (AP) — Meagher County, Montana, may not be much different than the rest of the rural enclaves across America that voted overwhelmingly for Donald Trump last fall.

The median annual household income is $38,000 — about 25 percent below the national average. Nearly 20 percent of its 1,800 residents live in poverty. And more than one in four people don’t have health insurance.

Yet few people in this conservative bastion ringed by prairies, meandering rivers and snow-frosted peaks are publicly complaining about Trump’s push to repeal the Affordable Care Act — an issue that is front and center in a special election Thursday to fill Montana’s only U.S. House seat.

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“I think there are some aspects of it that are good, like keeping young people insured and coverage for pre-existing conditions, but some people expect other people to take care of them,” said Barry Hedrick, who owns 2 Basset Brewery on Main Street and has no qualms about seeing the current law repealed.

“This was going to be a train wreck like every government program that’s come along,” he said.

Despite all their protest, one in eight Meagher County residents are newly enrolled in Medicaid — the government health care program that was expanded to cover the working poor in Montana and other states. In all, more than a third of Meagher County depends on state-administered public health insurance programs.

Much of the anti-government rhetoric — particularly against the Obama health care law — has clashed with the need for health care in towns such as White Sulphur Springs, home to half of Meagher County residents.

Rob Quist, the Democrat running for the state’s congressional seat, has focused on how the high cost of health care conspires against Montanans. He supports single-payer health care, such as a Medicare-for-all program, but said the more realistic goal politically is to strengthen the current law.

For much of the campaign, Quist has been dogged by controversy over a financial tailspin that led to three state income tax liens, defaulting on a $10,000 loan and legal clashes over money. He has blamed his debts on medical bills, but critics assert his troubles stemmed from financial irresponsibility.

Meanwhile, Republican Greg Gianforte — who has been more concerned about burnishing his pro-gun credentials — has suggested repealing and replacing the current health care law while keeping some of its provisions, a tricky position in a state that has 77,000 new enrollees for Medicaid.

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In a teleconference with financial backers, he said he was thankful that Congress was beginning to take action, even though he hasn’t fully explained how he would fix the current law.

The president’s proposed budget released Tuesday would slash more than $600 billion from Medicaid over 10 years. That’s on top of enrollment cuts aimed at saving billions more in the Republican plan that narrowly passed the U.S. House.

The Congressional Budget Office is expected to release its financial analysis of the bill on Wednesday.

Like most of her neighbors in White Sulphur Springs, Carol Berg voted for Trump in November. But unlike many, she doesn’t mind saying the current health care law is a lifeline.

“We have all these pre-existing conditions and we’d never be able to afford insurance,” said Berg, who works as a hairdresser and upholster from her home. “I’m 55 and my husband is 60, and we have to have insurance.”

She said the subsidies they got from the law last year helped pay for the medical insurance that covered specialists and surgery after her husband was diagnosed with a rare condition affecting blood flow in his neck. In all, insurance covered about $100,000 in medical bills, she said.

Now they worry that their benefits will be taken away.

“Maybe congressmen should be paid the average wage of their constituents and have to buy their own insurance out of that,” Berg said. “Most of them have no clue what it’s like to be the working poor.”

In a protest vote, she and her husband cast absentee ballots for Libertarian Mark Wicks in the upcoming House race.

Others in town aren’t keen about opening up about their hardships or the government benefits that flow into their community.

“A lot of people look at Medicaid as a handout,” said Toni Taylor, a federal employee who has lived in the community for 38 years and knows of neighbors whose pride prevents them from signing up for government health care.

Rob Brandt, chief executive officer of Mountain View Medical Center in White Sulphur Springs, sees the health care law as a way for community hospitals across the state to survive. The bulk of his hospital’s revenues come from patients on public health insurance.

Unemployment is about 4 percent in White Sulphur Springs, famous for its mineral spas about a 90-minute drive east of the capital city of Helena. Many folks work two jobs, some for minimum wage.

Adam Maleski, 30, who works in the kitchen of one of the town’s taverns, said he makes too much to qualify for Medicaid but not enough to afford premiums for private insurance. He said he is trying to pay off steep medical bills amassed after his car rolled over nearly two years ago when he was uninsured.

“I would rather wait to get everything paid off before I buy insurance. I don’t have health insurance, and I’m getting dinged on my taxes,” he said.

Across the street, Chris Nielsen was waiting for customers to stroll into his barbershop. He said he doubts that Washington will find a solution anytime soon or that Quist or Gianforte will add much to the conversation.

“There’s too much bickering in Washington, no matter who’s in charge,” Nielsen said.

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Follow Bobby Caina Calvan on Twitter at @bobbycalvan