Postgresql pg_hba.conf changes are ignored or not loaded
Figured it out.  This was a long shot, but it may help someone who has exhausted the normal avenues or is not used to postgres.

The server I was working on had another instance running through puppet, and so the config I was modifying was not for the instance I was connecting to.

run find / -name 'postgresql.conf' to see if there are any other locations where you might have a postgres instance.