Donald Trump promised to remake the American economy if voters returned him to the White House. Now that they have, his plans are likely to hit Minnesota more painfully than other parts of the nation.

The economy and immigration were top issues for Minnesota voters on Tuesday, according to Associated Press exit polls. Yet our state’s economic pressures are not the same as those that dominated the presidential campaign rhetoric.

The influx of undocumented immigrants from the nation’s southern border has been far smaller in Minnesota, which is so distant from it. Estimates vary but one that seems consistent is that around 30,000 people arrived over the past couple years, a figure that amounts to about 1% of the state’s workforce.

Not all are working but, even so, Minnesota’s workforce hasn’t been damaged by their presence. In fact, the workforce is actually smaller than it was before the pandemic shutdowns in spring 2020.

If Trump follows through on plans to reduce the number of illegal immigrants in the country, that shrinking of the nation’s labor force will add to the pressure Minnesota’s employers feel. Vice President-elect J.D. Vance, as an Ohio senator and on the campaign trail with Trump, has repeatedly said millions of Americans have been pushed to the employment sidelines because of competition from immigrants.

It’s a theory that, if tested by a mass deportation of recent immigrants, will be felt more acutely in Minnesota. The state, like many in the northeast and Midwest with older populations, has a greater proportion of people out of the workforce because they are retired, not because they are discouraged from seeking jobs.

In the last four years, Minnesota at times had the lowest rate of unemployment in the country and the highest rate of labor force participation. Those two things make for tight labor conditions. Today, Minnesota jockeys with a handful of other states for the nation’s tightest labor availability.

During Trump’s first term in office and in the years since, the real question in Minnesota has been: How can we get more workers?

With a client base of 500 to 600, a fraction of the 2,000 to 3,000 they might see in a major health system, a DPC doctor charging an average monthly per person fee of $80 would generate around $500,000 in annual revenue. That would well cover the average salary for a family doctor, which is about $225,000 nationwide, and leave room to pay for other expenses, perhaps an office administrator and part-time nurse.

For patients, the calculation can be more complex. Slings and Vang told me most of their patients maintain insurance to cover emergencies or the prospect of hospitalization. Some turn to health shares, many of which are organized by faith organizations and serve as pools of funds designed to cover catastrophic care for their members.

If the deductible on your medical coverage is high, like mine, then taking on the additional fees of going to a DPC doctor represents a gamble.

It will pay off if you wind up visiting the doctor two or three times in a year on top of a physical. That’s because for most single adults with a high deductible policy, a physical is usually covered but each additional visit can be several hundred dollars, costs paid out of pocket until reaching the deductible of $2,000 or $3,000 or more. Cumulatively, those out of pocket costs could exceed the annual cost of a DPC doctor.

For a couple or family, it seems to me there’s a greater likelihood of needing a doctor multiple times before reaching the deductible, even if that threshold is higher than for a single person.

Of course, even if it costs extra, some people may feel it’s worthwhile to have more time and quicker access with a doctor. If direct primary care proliferates, new types of insurance may form around it.