Democrats push Medicaid expansion for rural Georgia left behind

ARLINGTON, Georgia — Nine years after the hospital closed in the southwestern Georgia city of Arlington, concern about health care lurks. Health insurance premiums are high, many residents are reporting poor health, and there’s no guarantee that Calhoun County’s only ambulance will arrive quickly if it takes a patient to a distant hospital.

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

Arlington, home to 1,209, reflects rural Georgia’s health care struggles.

Democrats, including their gubernatorial candidate Stacey Abrams, are presenting these issues as they run for office this year, pushing Georgia to join 38 other states in expanding the Medicaid health insurance program to cover all able-bodied adults.

Abrams opened his campaign to oust Republican Brian Kemp at a hospital that closed in nearby Cuthbert, pointing to an issue that was at the center of his narrow loss to Kemp in 2018.

“We’re talking about someone who goes in for a checkup and they’re told they have stage one pancreatic cancer,” Abrams told reporters in a video news conference this month. “In Georgia, they don’t get a follow-up visit unless they can pay out of pocket.”

Experts predict that more than 450,000 uninsured Georgians would receive coverage if Medicaid were expanded. Many generally don’t qualify for subsidies to buy individual policies, leaving them in what experts call the “coverage gap.”

Medicaid expansion is also an issue elsewhere this year.

In South Dakota, voters will decide on an expansion referendum opposed by Republican Gov. Kristi Noem. In Kansas and Wisconsin, Democratic governors are seeking re-election after failing to persuade Republican legislatures to expand coverage.

In Georgia, Kemp has declined calls for expansion, instead offering coverage for a smaller group of people who meet work, education or volunteer requirements. In an Oct. 11 letter to Democratic members of the Georgia Congress, Kemp called the full expansion of Medicaid a “failed one-size-fits-all” policy.

But that refusal stings Arlington, which was once home to the 25-bed Calhoun Memorial Hospital. It had been decades since babies were born at Calhoun Memorial, and the facility struggled to afford the latest technology. Although services were limited, local residents relied on her for emergencies.

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

Conner chairs the county hospital’s board of directors, nine years after the facility closed and 99 employees were laid off. With many patients uninsured, Conner said the hospital was providing more than $2 million a year in unpaid care when it closed.

The county government borrowed for a new roof in 2008, and it’s a local sore spot that taxpayers still owe nearly $500,000 on the building, now leased to a drug and alcohol rehabilitation center. Local officials have refused to raise property taxes to cover hospital deficits, unlike some counties in Georgia. The hospital sold its nursing home, raising funds but clouding the long-term financial outlook. Eventually, authorities decided to close, joining eight other rural hospitals in Georgia since 2008.

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

However, the health issues run deeper in southwest Georgia. Private health insurance is so expensive that Conner, whose family owns an insurance agency, buys coverage on the federal health insurance market instead. Robinson said he and his wife once paid $1,000 a month for the insurance.

Kemp succeeded in lowering insurance rates and encouraging more insurers to offer coverage outside of metro Atlanta with subsidies. But premiums remain 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 teenage births, according to county health rankings data. Black residents are much more likely to have preventable hospital stays.

Sherrell Byrd of SOWEGA Rising, which is trying to improve wellness in southwest Georgia, said COVID-19 has exposed the region’s poor health and rickety health care system. At the start of 2020, Southwest Georgia captured national attention with one of the highest death rates from the respiratory virus.

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

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

President Barack Obama’s 2010 health care overhaul envisioned states providing Medicaid coverage to residents whose incomes reached up to 138% of the federal poverty level. But the United States 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 tried to block Kemp’s plan for a partial Medicaid expansion, but a judge in August ruled Georgia could pursue the work requirement. Kemp calls his approach “a much better approach to increasing health care coverage than the ‘full’ expansion of Medicaid.”

Kemp notes that Medicaid expansion would force some people now eligible for Medicaid private health insurance subsidies. Because Georgia has set low Medicaid payments and some doctors aren’t taking Medicaid, Kemp says it would make things worse for those people while increasing competition for current Medicaid patients to find a doctor.

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

Democratic Sen. Raphael Warnock has tried to sweeten the deal, prompting lawmakers last year to increase the federal share of funding from 90% to 95% for the first two years of any new Medicaid expansion. Warnock, who is seeking re-election on Nov. 8, has long called for broader coverage. He was arrested during protests over the issue at the Georgia Capitol in 2014 and the United States 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 void of coverage,” Warnock said Oct. 12 in Atlanta. “And I intend to keep fighting for them.”

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

“Right now Medicaid hasn’t been good,” he told reporters. “Right now, the expansion is going to keep bankrupting us. Everyone knows that.”

A key question underpinning the debate is the extent to which government is obligated to provide health care and seek better health outcomes. Democrats now widely 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 really existed was a lag — with hospitals legally obligated to provide emergency care, but with no guarantee of payment.

“It makes me think that universal health care might actually be a right of our citizens,” Conner said. “It’s a right for them to go to the emergency room whether they can pay or not. But it’s not a right for the hospital to get the money to pay for it.”

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