Georgia’s poor, rural hospitals lose in lawmakers’ health care waiting game

Our columnist asks why would state lawmakers spend hundreds of millions of dollars on tax cuts, rather than on helping hundreds of thousands of uninsured Georgians through Medicaid expansion, helping rural hospitals stay open and leveraging literally billions in federal aid? The 50-bed North Georgia Medical Center in Ellijay closed in 2016 citing the burden of uncompensated care. John McCosh/Georgia Recorder

Georgia lawmakers are again waiting, fingers crossed, for someone to provide an alternative to expanding Medicaid coverage to nearly 500,000 uninsured Georgians under the federal Affordable Care Act.

The latest workaround, Georgia’s 2019 Patients First Act, is so much like a Utah plan the White House just rejected that it seems like it’s time to move on to better options—and quickly.

Still, state lawmakers and the governor say they’ll wait and hope for the best. It’s a strategy stubbornly ingrained in Georgia’s political culture when it comes to helping our state’s working poor get decent medical care.

Georgia leaders didn’t want to rush into anything after the 2010 federal health law went into effect in case the U.S. Supreme Court ruled it unconstitutional. Two years later, when the court upheld much of the law, Gov. Nathan Deal once again delayed accepting federal funds to help offset the costs of providing health care to Georgians in need. Instead, he held out hope that President Barack Obama would lose his bid for a second term, and Congress would kill the Affordable Care Act. That didn’t happen.

State lawmakers briefly entertained a Medicaid expansion plan in fall 2016 but shelved it soon after the November presidential election. Newly elected President Donald Trump vowed to kill the act. That didn’t happen either.

Elected officials in Georgia have now spent nine years dragging their feet on accepting federal funds that could help lower our state’s high 13% uninsured rate that’s one of the nation’s worst and help shore up our financially struggling rural hospitals.

Meanwhile, legislators keep studying the problem, instituting half measures and kicking the can down the road.

This year, they tossed a bureaucratic lifeline to Georgia’s rural health system with a five-year extension of a $60 million tax credit program to encourage people to make charitable donations to eligible rural hospitals.

How are Georgia’s most distressed hospitals using the donated funds, which are not guaranteed to return next year? Many of the 58 hospitals on the Georgia Department of Community Health’s most-distressed list say they need the money to cover people who can’t pay.

Burke County Hospital says it will use its $714,000 in donations to offset the cost of uncompensated care and to recruit a doctor and nurse. Mitchell County Hospital is using $488,000 donated in 2018 to offset the “tremendous (over $8 million) of uncompensated care” it anticipates over the next five years.

More than a third of these uninsured patients statewide would have access to health insurance if Georgia’s politicians would use readily available federal funds to expand Medicaid. If our state adopted a Medicaid expansion plan similar to what’s already operating in 37 states, the feds would cover 90% of the cost of insuring the nearly half a million Georgians who now go without health coverage.

The state’s current plan — the one that’s awfully similar to the recently rejected Utah plan — would insure only about 250,000 Georgians. And chances are the feds would offset just 67% of the cost.

Legislators continue to find new ways to study this old problem, which they’ve allowed to fester and worsen since 2010. Last year about this time a House study committee recommended raising the annual donation cap to rural hospitals. In 2017 it discussed what became the current waiver plan. This month, a powerful group of lawmakers gathered in Jasper to kick off a roadshow to once again study ways to pump up rural Georgia. The rural health care crisis seems sure to return to the agenda.

Clearly, waiting and wishing and hoping and waiting some more is not working when it comes to connecting Georgia’s working poor to decent health care and helping rural hospitals keep their doors open.

With moral and financial stakes this high, our politicians’ waiting game is irresponsible and downright cruel.

John McCosh
John McCosh, Editor-in-Chief, is a seasoned writer and editor with decades of experience in journalism and government public affairs. His skills were forged in Georgia newsrooms, where he was a business and investigative reporter, editor and bureau chief, and expanded his experience during years in nonprofit and corporate communications roles. For more than a decade at the Atlanta Journal-Constitution, McCosh investigated state and local government officials and operations. He also tracked regional growth and development with a focus on metro Atlanta’s population-related problems, including traffic congestion, air pollution and water quality. He first learned the power of public records to unlock information when he was a commercial real estate reporter at the Atlanta Business Chronicle. McCosh is a board member of the Georgia First Amendment Foundation and active in the Georgia State Signal Alumni Group, which advises student journalists.


  1. Loved the article on the plight of rural hospitals. Not only are our legislators cruel they are criminals! They hate the people of the great State of Georgia more than they hated President Obama!!!

  2. I don’t understand why these people keep voting for these bums! Maybe they don’t, and the bums keep on going with election fraud. They need to cheat to stay in office.

  3. John, An unaddressed problem with the idea of expanding medicaid is that it is not “insurance.” The federal law creating medicaid states that medicaid payments is calculated to merely cover costs and not allow physicians to profit. Medicaid and its contractors are notorious for offering coverage for which they refuse to pay. One tiny example: children are covered for routine vision exams, designed to prescribe glasses for kids who need them. Early in 2019 without announcement they stopped paying the whopping $30 reimbursement for these exams for anyone under 15 with diagnosis of myopia–this is the primary purpose of these exams, getting glasses for nearsighted kids! Medicaid makes dealing with Medicare look like a dream!


Please enter your comment!
Please enter your name here