A growing population of uninsured and underinsured heading to the emergency room with little or no ability to pay for their care is one of several alarming trends that Jacksonville, FL-based healthcare officials say will make 2009 a challenging year. The healthcare industry has a direct economic impact of $7 billion in Jacksonville, according to the Center for Global Health and Medical Diplomacy at the University of North Florida. It also employs one in six Jacksonville residents, and is the fastest-growing segment of employment in the region.