Editor’s note: This new monthly column from staff writer Laura Weiss will look to localize health and wellness issues for our readers to better bring in to focus how larger issues hit home.

Repeal and replace is still on the president’s agenda, but in Fairfield County, how has health care changed? And for who?

After Republicans’ Obamacare replacement bid crumbled, President Donald J. Trump threatened government subsidies vital to continued health care for millions last week if Democrats don’t negotiate. In Fairfield County, the Affordable Care Act has significantly decreased the uninsured, and entrepreneurs and the self-employed are able to buy more solid, valuable plans, an expert said. Experts weren’t confident a viable Republican replacement is coming.

But while the ACA’s impact is somewhat lesser in Fairfield County’s wealthier towns where more residents get employer-provided health insurance, Medicare or another retiree plan, expanding coverage for low-income residents and better plans for self-employed people buying their own health care coverage have likely boosted the communities, according to the experts. And more insured patients means benefits for all.

The ACA does have its flaws, drawing critiques for rising costs as some insurance companies back out, inadequate subsidies and rising premium costs. While imperfect, “it’s way better than what was there before,” said Ted Doolittle, Connecticut’s Healthcare Advocate, responsible for helping residents navigate health care and attain rightful coverage.

Plus, lucky 20-somethings are able to stay on their parents health care until age 26, people with pre-existing medical conditions can no longer be denied coverage and women can’t be charged more for women’s care than men’s — all results of popular legal changes enacted by the ACA.

So aside from its overall reach, who in towns like Darien, Fairfield, New Canaan and Westport has been directly impacted?

In Darien, 579 residents are on qualified health care plans through the health insurance marketplace, according to Access Health CT Government and Public Relations Manager Kathleen Tallarita. In New Canaan, 652 are on an exchange plan, along with 1,104 in Westport and 1,903 in Fairfield. For the four towns, 53 percent on those plans receive financial help from government tax credits.

Those residents could include high income but self-employed residents, Doolittle noted, adding the individual insurance market has meant better plans for those Americans. Many formerly had “really shoddy products” with flimsy coverage.

The communities are also being served by Medicaid, health insurance for lower-income Americans and some with disabilities. Connecticut was among states that chose to expand the program. Eight hundred ninety-six Darien residents on average received Medicaid coverage from July 2015 to June 2016, along with 839 New Canaan residents, 1,489 Westport residents and 5,786 Fairfield residents, according to data provided by the state’s Department of Social Services.

In Bridgeport, for example, 65,567 people receive Medicaid. So while about 44 percent of the city’s residents can afford treatment from the service, 4 percent each of Darien and New Canaan, 5 percent of Westport and 9 percent of Fairfield residents benefit. Still, the towns are not immune to that need.

According to Doolittle and Angela Mattie, professor and chair of Quinnipiac University’s department of health care management and organizational leadership, better health care for more Fairfield County residents also helps reduce burdens on area emergency rooms, which can mean better care for all. If someone has insurance, they won’t need to turn to the ER for an ear infection because they can’t get appropriate care, and they won’t wait until a curable problem is severe, warranting more resources and costly care. So that dreaded ER wait might be shorter and people get the proper care they need.

What could the future hold?

Republicans’ failed health care replacement would’ve had a tax benefit to Fairfield County’s upper stratum, Doolittle pointed out, cutting an ACA tax on wealthy Americans. But even those that didn’t lose insurance under the plan, he said, would see the quality of their coverage decline.

“Do I think it’s off the agenda? No,” Mattie said of a Republican repeal and replace. “Nobody has a crystal ball.” But, she fears ambiguity in the environment could lead insurers not to invest in exchanges. Instead of fixing ACA flaws, the situation could worsen.

She doesn’t see the ACA as perfect, but said more health care coverage leads to good things for all, adding, “I just hope we don’t throw the baby out with the bathwater.”

Laura Weiss is an education and crime reporter in Westport and Fairfield for Hearst Connecticut Media. With a passion for health, she has written about medical research, drug costs and Ebola at the height of the 2014 epidemic in West Africa. In Health Check, she'll be talking with experts and providers to check up on a different health topic each month in Darien, New Canaan, Westport and Fairfield.