Unless the U.S. Supreme Court decides to upend the entire apple cart this summer, America will soon find itself divided into two separate health care systems.
One will be a place where the Affordable Care Act is embraced with all its cost and complexity. The other America wants no truck with Obamacare, and so must find another way to provide health care for those who can’t afford it.
That's what made last week's report by the Rural Hospital Stabilization Committee so important. This is Gov. Nathan Deal's second major effort at salvaging rural Georgia's health care safety net. A measure backed by the governor last year, to allow some rural hospitals to devolve into standalone emergency rooms, has proven ineffective.
“Georgia has virtually no rural hospitals in counties capable of supporting an [emergency room] without outside subsidies,” the study committee noted in its opening paragraphs.
Four rural hospitals have closed in recent months, the report noted. Fifteen are considered “financially fragile,” and six are “operating on a day-to-day basis.”
The report issued by Deal’s committee made no mention of Medicaid expansion under the Affordable Care Act. That topic is off-limits, given the climate in the state Capitol.
Instead, the hospital rescue committee put its faith in the Internet. With a $3 million pilot program, “tele-medicine” links will be established between four hospital “hubs” with emergency rooms and the surviving “spokes” in rural Georgia’s health care system – including small hospitals, physicians, ambulance attendants, local health departments, and school nurses.
That’s right, school nurses – they have become slender but vital threads in rural Georgia’s health care net, although the inventory is rather small. Georgia’s 75 smaller school systems, which serve fewer than 3,000 students, boast a total of 145 school nurses. Twenty-one of those systems only have one. Two don’t report having any.
Lincoln County has two, and they have become very important figures in the community, said Wade Johnson, chairman of the Lincoln County Commission. He is a member of the governor’s rural hospital committee.
Located north of Augusta, on the banks of the Savannah River, Lincoln’s population of 8,000 is too small to support a hospital. “It takes us a whole year of sales tax to get $600,000,” Johnson said. “Our hospitals amount to our ambulances. Our doctors are ambulance attendants or EMTs.”
Even that puts a strain on Lincoln County finances. Both county-owned ambulances recently had engine problems that cost $5,000 each. Medicaid reimbursements for the ambulance service fall $20,000 short every three months.
So tele-medicine, which might weed out unnecessary ambulance rides, is nothing to scoff at, Johnson said.
On the day the rural hospital report was released, committee co-chairman Terry England, chairman of the House Appropriations Committee, was on GPB’s “Lawmakers.”
“A lot of [the report] deals with going in and looking at the health care delivery system in the state now, and making it more efficient,” England said. “There is a way to make this work.”
But the report by the Rural Hospitalization Stabilization Committee wasn’t complete, as those who wrote it know very well. The road that they outlined lacks a sustaining financial model.
Who pays for those who can’t – the problem that the federal ACA has attempted to solve – remains an unanswered question in Georgia. But perhaps not for long.
On that same “Lawmakers” program was Jack Hill, R-Reidsville, chairman of the Senate Appropriations Committee. “It’s definitely a fact that local governments will have to participate, in many, many cases, in the saving of their local hospital,” Hill said. “I don’t think the state can fund and keep afloat hospitals across the state. We have twice as many hospitals as they have in South Carolina.”
In other words, the America that eschews Obamacare may be headed back to the future. If communities want the economic development boost that a hospital and decent health care can bring, they’ll have to pony up – as they did decades ago.
“Used to be, more counties did give a mill or two to the hospital. We’ve gotten away from that. But I think we’ll see more of this,” said Monty Veazey, who sits on the board of the Georgia Rural Health Association, which has advocated an expansion of Medicaid.
Fulton and DeKalb counties have long supported Grady Memorial Hospital in Atlanta. Last year, Clayton County gave a $50 million bailout to Southern Regional Medical Center.
But the practice is spreading to rural Georgia. Also last year, Habersham County agreed to assume bond payments on $37 million in debt owed by a local hospital. Ultimately, it will assume control of the facility. As justification, the northeast Georgia county cited preservation of its mountain tourism industry.
Elbert County commissioners voted last year to increase a property tax to sustain Elbert Memorial Hospital in Elberton. In Dodge County, they tell a similar story.
“It’s kind of like a school system. If you lose it, you’re not going to get it back,” Veazey said.
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