Bookman: Lifeline for struggling rural hospitals not in Kemp’s plans

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

The limited Medicaid waiver program proposed this week by Gov. Brian Kemp is a sorry excuse for doing almost nothing. At its best, it can extend health insurance to 50,000 Georgians while leaving 10 times that number eligible but uncovered.

The problems with Kemp’s approach are no secret. Similar “work-based” programs in Indiana and Arizona have already been abandoned. The program in Arkansas has been ruled illegal by a federal judge and in Kentucky, the Republican governor who championed such changes was defeated this week in a state that Donald Trump carried by 30 percentage points.

Admittedly, a slightly different story played out in the governor’s race in deep-red Mississippi this week, where Medicaid expansion was also a major issue. The Republican candidate for governor won there by a margin of six percentage points. But to put it into context, the GOP candidate for that office four years earlier won by 34 points, and Donald Trump carried the state by 18.

The question you have to ask yourself is why. Nine years after the passage of the Affordable Care Act, why do Kemp and Georgia’s Republican leadership still stubbornly refuse to do what logic, decency, politics and basic math dictate they do, which is to allow the expansion of Medicaid and thus provide health insurance to hundreds of thousands of their own citizens who have no other way to pay for health care.


They claim it’s about money; it’s not really about money.

According to a study released by state officials in January, we could insure 500,000 Georgians at at an annual net cost to the state of $150 million, which is 0.55% of the state budget. Put another way, the tax cut that Republican legislators still plan to approve in the upcoming session would cost the state an estimated $550 million annually, with most of the benefits going to the affluent. So while we supposedly can’t afford Medicaid expansion, we can somehow afford a tax cut that costs the state almost four times as much.

Clearly, it’s not about money, it’s about values. Our state’s current leadership lives by the philosophy that the only people who deserve help from government are those who are wealthy and powerful enough not to need help from government, but who want it anyway.

Because of that philosophy, Georgia has the third-highest rate of uninsured in the country, leading to premature deaths and lives lived in unnecessary pain. Because of that philosophy, we also rank third in the country in the number of rural hospitals that have closed since 2010, behind Texas and Tennessee, two other states that have refused to accept Medicaid expansion.

According to Deloitte, the consultant hired by Kemp to study Georgia’s health-care delivery system, another 26 rural hospitals in the state are struggling to stay open. As Deloitte also reported, “Georgia ranks 46 out of 50 overall on clinical measures for access to quality healthcare and preventive services … such as primary care physicians and mental health providers.”

That’s what makes this so frustrating. Kemp was elected largely because of strong support from rural areas and small towns, yet he and others refuse to do the one most important thing they could do to extend lifespans, boost rural economies and simply make life better all around.

In the past, Kemp has argued that Medicaid expansion couldn’t help rural areas and small towns because those areas lack doctors, nurses and hospitals that would be needed to provide medical care. That right there is some high-quality bass-ackwards thinking. The reason that we don’t have enough doctors, nurses and hospitals working in those areas is because they don’t have enough insured and paying customers to let them make a living. Expand health insurance, and the economics change. Lives change. Opportunities change.

But apparently, none of that’s going to happen until political leaders are changed.

Jay Bookman
Jay Bookman covered Georgia and national politics for nearly 30 years for the Atlanta Journal-Constitution, earning numerous national, regional and state journalism awards. He has been awarded the National Headliner Award and the Walker Stone Award for outstanding editorial writing, and is the only two-time winner of the Pulliam Fellowship granted by the Society of Professional Journalists. He is also the author of "Caught in the Current," published by St. Martin's Press.