Dems are ramping up Medicaid expansion for rural Georgia left behind

Nine years after the hospital closed in the southwest Georgia city of Arlington, health care concerns lurk. Health insurance premiums are high, many residents report poor health, and there is no guarantee that Calhoun County’s only ambulance will arrive on time when transporting a patient to a distant hospital.

“If it’s a phone call, you might as well throw them in the truck and try to get somewhere,” resident Sam Robinson said.

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

Democrats, including their nominee for governor Stacey Abrams, are flaunting these issues as they run for office this year and are urging Georgia to join 38 other states in expanding the Medicaid health insurance program to all able-bodied adults .

Abrams opened her campaign to impeach Republican Brian Kemp at a hospital that was closing in nearby Cuthbert, underscoring an issue that was a centerpiece of her narrow loss to Kemp in 2018.

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

Experts estimate that more than 450,000 uninsured Georgians would receive coverage if Medicaid were expanded. Many do not typically qualify for individual policy purchase subsidies, leaving them in what experts call a “funding gap.”

Medicaid expansion is also a topic elsewhere this year.

In South Dakota, voters will hold a referendum on expansion, which Republican Gov. Kristi Noem rejects. In Kansas and Wisconsin, Democratic governors are seeking re-election after failing to persuade Republican lawmakers to expand coverage.

In Georgia, Kemp has rejected calls for an expansion, instead proposing coverage for a smaller group of people who meet work, education, or volunteering needs. In an Oct. 11 letter to Democratic congressmen in Georgia, Kemp called full Medicaid expansion a “failed one-size-fits-all policy.”

But that refusal stands out in Arlington, which once housed the 25-bed Calhoun Memorial Hospital. It had been decades since babies were born at Calhoun Memorial and the facility was struggling to afford the latest technologies. Although services were limited, local residents relied on it in emergencies.

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

Conner serves as chair of the county hospital board nine years after the facility closed and laid off 99 employees. Conner said the hospital, with many uninsured patients, was providing more than $2 million annually in unpaid care when it closed.

The county government took out a loan for a new roof in 2008, and it’s a local sore that taxpayers still owe almost $500,000 on the building, which is now leased to a drug and alcohol rehabilitation facility. Local officials declined to collect property taxes to cover hospital deficits, unlike some Georgia counties. The hospital sold its nursing home, raising money but tarnishing long-term financial prospects. Eventually, officials decided to close, joining eight other rural Georgia hospitals since 2008.

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

In Southwest Georgia, however, the health problems run deeper. Private health insurance is so expensive that Conner, whose family owns an insurance agency, uses the federal health insurance market instead. Robinson said he and his wife paid a combined $1,000 for insurance once a month.

Kemp has managed to lower insurance rates and encourage more insurers to offer coverage outside of the greater Atlanta area with subsidies. But premiums remain high in Southwest Georgia as a large hospital in Albany dominates the market and residents are often in poor health. According to County Health Rankings data, Calhoun County has high rates of diabetes, obesity and teen births. Black residents are much more likely to have avoidable hospitalizations.

Sherrell Byrd of SOWEGA Rising, which seeks to improve well-being in southwest Georgia, said COVID-19 has highlighted the area’s poor health and shaky healthcare system. In early 2020, southwest Georgia attracted national attention with one of the highest death rates from the respiratory virus.

“It really showed how bad our health is,” Byrd said. “We had so many comorbidities here.”

Medicaid has also become an issue in Atlanta, where the WellStar scheme has closed a hospital in suburban East Point and will close the 532-bed Atlanta Medical Center by Nov. 1. This is one of only five premier trauma centers in Georgia. WellStar says Atlanta Medical Center lost so much money that expanding Medicaid wouldn’t have helped, but Democrats insist it could have made a difference in the long run.

President Barack Obama’s 2010 health care reform mandated that states provide Medicaid coverage to residents with incomes up to 138% of the federal poverty line. But the US Supreme Court ruled in 2012 that the federal government cannot force states to act, and many Republican-led states balked.

President Joe Biden’s administration has tried to block Kemp’s plan for a partial Medicaid expansion, but a judge ruled in August that Georgia could proceed with the work request. Kemp calls his approach a “far better approach to increasing healthcare than a ‘full’ Medicaid expansion.”

Kemp notes that expanding Medicaid would force some people who are now eligible for private health insurance subsidies into Medicaid. Because Georgia has set low Medicaid payments and some doctors don’t take Medicaid, Kemp argues that doing so would put those people worse off while increasing competition for current Medicaid patients to find a doctor.

The governor also notes that 600,000 more Georgians are now on Medicaid than when he took office, essentially arguing that Medicaid expansion has already happened. However, many people are covered because the federal government has blocked states from weaning people off Medicaid during the COVID-19 pandemic. They could be removed once the federal health emergency ends.

Democratic Senator Raphael Warnock has tried to sweeten the deal by baiting lawmakers last year to increase the federal share of funding from 90% to 95% in the first two years of a new state Medicaid expansion. Warnock, who is seeking re-election on November 8, has long called for broader coverage. He was arrested at protests over the 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, leaving hundreds of thousands of working Georgians underfunded,” Warnock said Oct. 12 in Atlanta. “And I intend to keep fighting for her.”

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

“Right now, Medicaid wasn’t good,” he has told reporters. “Right now, expansion will continue to drive us into bankruptcy. Everyone knows that.”

A key question underlying the debate is the government’s obligation to provide health care and to strive for improved health outcomes. Democrats now largely believe that health care is a human right and a collective responsibility. Many Republicans still believe it’s an individual responsibility.

In Arlington, Conner says what actually existed was a mismatch — with hospitals legally required to provide emergency care but no guaranteed payment.

“That makes me say that universal health coverage might actually be a right of our citizens,” says Conner. “You have the right to go to the emergency room whether you can pay for it or not. But it has no right for the hospital to get the money for it.”

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This article appears on Now Habersham through a news partnership with GPB News

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