Democrats Push to Expand Medicaid in Rural Georgia

Arlington, Georgia – Nine years after the hospital was closed in the southwestern Georgia town of Arlington, the worry about it Health Care lurks. Health insurance premiums are high, and many residents say they are poor health And there is no guarantee that the only ambulance in Calhoun County will arrive immediately if it is transporting a patient to a remote hospital.

“If the call is outside, you can also throw it in the truck and try to get somewhere,” said resident Sam Robinson.

Arlington, with a population of 1,209, reflects the health care difficulties of rural Georgia.

Democrats, including their candidate for governor, Stacey Abrams, are exposing those problems as they run for office this year, pushing Georgia to join 38 other states in expanding Medicaid to all healthy adults.

Abrams opened her campaign to oust Republican Brian Kemp at a closed hospital in nearby Cuthbert, underscoring a problem that was the focus of her narrow loss to Kemp in 2018.

“We’re talking about someone who goes in for a test and is said to have stage 1 pancreatic cancer,” Abrams told reporters at a video news conference this month. “In Georgia, they are not entitled to a follow-up visit unless they can pay out of their pocket.”

Experts predict that more than 450,000 uninsured Georgians will get coverage if Medicaid is expanded. Many do not usually qualify for subsidies to purchase individual policies, leaving them in what experts call a “coverage gap.”

Medicaid expansion is also an issue elsewhere this year.

In South Dakota, voters will decide to hold a referendum on the expansion, which Republican Governor Kristi Noem opposes. In Kansas and Wisconsin, Democratic governors seek re-election after failing to persuade Republican legislatures to expand coverage.

In Georgia, Kemp rejected calls for expansion, instead proposing coverage for a smaller group of people who meet work, education or volunteer requirements. In an Oct. 11 letter to Georgia Democratic lawmakers, Kemp described the entire Medicaid expansion as a “one-size-fits-nothing failed” policy.

But that rejection is stinging in Arlington, which was once home to the 25-bed Calhoun Memorial Hospital. It’s been decades since babies were born at Calhoun Memorial and the facility struggles to afford the latest technology. Although services are limited, local residents have relied on them for emergencies.

“I used the emergency room with my son,” Pam Conner said. “He was 4 years old when he got his first wasp sting. I put him into anaphylaxis. I don’t know what we would have done without a hospital.”

Conner chairs the county hospital board, nine years after closing the facility and laying off 99 employees. With so many uninsured patients, Conner said the hospital was providing more than $2 million annually in uncompensated care when it closed.

The county government borrowed a new roof in 2008, and it hurts locally that taxpayers still owe about $500,000 on the building, now leased to a drug and alcohol rehabilitation facility. Local officials refused to raise property taxes to cover the hospital deficit, unlike some Georgia counties. The hospital sold its nursing home, raising funds but clouding long-term financial prospects. Finally, officials decided to close, joining eight other rural hospitals in Georgia since 2008.

Now, Arlington residents rely on one ambulance in the county, 12 miles away in Morgan. Calhoun County expects it will spend $537,000 to provide emergency medical services this year, more than one-eighth of its $4.2 million budget.

However, health care problems are deeper in southwest Georgia. Private health insurance is so expensive that Conner, whose family owns an insurance agency, buys coverage through the federal health insurance marketplace. Robinson said he and his wife once paid $1,000 a month for insurance.

Kemp has succeeded in lowering insurance rates and encouraging more insurers to offer coverage outside of Metro Atlanta with subsidies. But premiums are still high in southwest Georgia, with a large hospital in Albany dominating the market and residents often in poor health. Calhoun County has high rates of diabetes, obesity and teen births, according to data from county health rankings. Black residents are more likely to have preventable hospital stays.

Sheryl Bird of SOWEGA Rising, which is trying to improve well-being in southwest Georgia, said COVID-19 has highlighted the region’s deteriorating health and crumbling health care system. In early 2020, southwestern Georgia drew national attention with one of the highest death rates from a respiratory virus.

“It really revealed how bad our health is,” Baird said. “We had a lot of comorbidities here.”

Medicaid has also caught on as an issue in Atlanta, where the WellStar system has closed a hospital in an East Point suburb and will close by November 1 the 532-bed Atlanta Medical Center. This is one of five top-level trauma centers in Georgia. WellStar says Atlanta Medical Center has been losing so much money that Medicaid expansion wouldn’t have helped, but Democrats insist it could have made a difference in the long run.

States providing Medicaid coverage to residents with incomes up to 138% of the federal poverty line was envisioned in President Barack Obama’s 2010 health care reform. But the US Supreme Court ruled in 2012 that the federal government could not compel states to act, and many rejected Republican-led states.

The administration of President Joe Biden is trying to block Kemp’s plan to expand the partial Medicaid program, but a judge in August ruled that Georgia could go ahead with the business requirements. Kemp describes his approach as “a much better approach to increasing health care coverage than a ‘full’ Medicaid expansion.”

Kemp notes that expanding Medicaid will force some people who are now eligible for private health insurance benefits onto Medicaid. Because Georgia has set Medicaid payments low and some doctors are not taking Medicaid, Kemp argues that would leave these people worse off as competition increases for existing Medicaid patients to find a doctor.

The governor also notes that there are 600,000 more Georgians on Medicaid now than when he took office, arguing that the Medicaid expansion has already occurred. However, many people are covered because the federal government has prevented states from dropping people from Medicaid during the COVID-19 pandemic. They can be removed once the federal public health emergency is over.

Democratic Senator Raphael Warnock has tried to fine-tune the deal, enticing lawmakers last year to increase the federal share of the funding from 90% to 95% within the first two years of any new expansion of the state’s Medicaid program. Warnock, who is seeking re-election on November 8, has long called for wider coverage. He was arrested during protests over this issue at the Georgia Capitol in 2014 and the US Capitol in 2017 before becoming a senator.

“Unfortunately, the state left that money on the table and left hundreds of thousands of working Georgians in the coverage gap,” Warnock said Oct. 12 in Atlanta. “And I intend to continue fighting for them.”

Warnock’s Republican opponent, Herschel Walker, said last month he was against expansion.

“Right now, Medicaid hasn’t been good,” he told reporters. “For now, expansion will continue to bankrupt us. Everyone knows that.”

A key question underpinning the debate is to what extent the government is committed to providing health care and striving to improve health outcomes. Democrats now largely believe that health care is a human right and a collective responsibility. Many Republicans still think it’s an individual responsibility.

In Arlington, Conner says that what was really there was a misalignment — with hospitals that are legally required to provide emergency care, but payment is not guaranteed.

“It makes me say that universal health care may actually be a right for our citizens.” But the hospital has no right to get the money to pay for it.”

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