“We pretty much quit paving. We just did the basic pothole repairs and that’s it,” Petelos said.

To generate cash, the county sold its nursing home for $11.3 million. In one of its most politically difficult decisions, it closed inpatient and emergency care at Cooper Green Mercy Hospital, which served the county’s lowest-income residents. The money-losing hospital was underutilized, with typically fewer than 40 patients a day, and received more than $10 million a year in county subsidies, Carrington said.

Although an urgent care facility remained open, the closing of the downtown hospital was hard for some residents because suburban hospitals weren’t on bus lines, said Scott Douglas, executive director of Greater Birmingham Ministries, a community organization.

“People lost connection with their doctors,” he said. “One issue was access and the second was speaking with a medical professional that you know.”

Jefferson County exited bankruptcy in December 2013, cutting its sewer debt to $1.8 billion. To pay off creditors, officials agreed to raise sewer rates 8% annually through October 2018, followed by yearly jumps of 3.5% until 2053.

The bond market also helped. Jefferson County, currently rated AA- by S&P Global Ratings, has issued debt twice since the bankruptcy and hasn’t been penalized by investors, said Carrington.

A refinancing of school debt freed up sales-tax revenue, allowing the county to hire back about 350 employees and fund road and bridge repair, economic development and deferred capital projects. The economy, anchored by the University of Alabama’s School of Medicine, banking, and automobile manufacturing, gained steam while residential development in Birmingham boosted property-tax revenue.

In a 2018 bond sale, the county paid a premium of 0.5% on the longest-maturing debt.

Now, it may be better prepared than others to weather the economic slowdown. It has built up more than $170 million in reserves, enough to cover half of its fiscal 2019 general-fund budget.

“One thing we learned in bankruptcy, is you better be prepared,” said Petelos, the county manager.