You can sort of think of it as applying the discount before or after tax. Say for example, we have a cart with a subtotal of $20, a discount of $10, and a tax of 10%.
The default method works similar to this:
(Subtotal($20) - Discount($10)) + ((Subtotal($20) - Discount($10)) * Tax(.10)) = Total($11)
(20-10) + ((20-10) * .10) = 11
With the exempt_discount_from_tax config added, it works similar to this:
Subtotal($20) + (Subtotal($20) * Tax(.10)) - Discount($10) = Total($12)
20 + (20 * .10) - 10 = 12
Now with that said, that config variable was only intended to be set once. It wasn't meant to be changed on the fly. If you need to be able to configure that variable based on country code, you'll need to modify a core cartthrob file.
In third_party/cartthrob/cartthrob/core/Cartthrob_cart.php
Line 1132. Change
if ($this->core->config('exempt_discount_from_tax') == TRUE)
to
if ($this->core->config('exempt_discount_from_tax') == "y")
Then inside your template you'll be able to set that config using the {exp:cartthrob:set_config}
tag pair.
{exp:cartthrob:customer_info}
{exp:cartthrob:set_config}
{set_exempt_discount_from_tax value='{if "{customer_country_code}" == "USA"}y{if:else}n{/if}'}
{/exp:cartthrob:set_config}
{/exp:cartthrob:customer_info}