On Dec. 4, up in the northwest corner of Georgia, Hutcheson Medical Center will close its doors for the last time.
The Fort Oglethorpe institution, which once employed 900 and had an annual payroll of $29 million, will be the fifth hospital in Georgia to fail in the last two years. To describe the clientele that the 179-bed facility once served as overwhelmingly Republican is to dabble in understatement.
The hospital’s obituary is sure to reignite the debate over whether the state should find a way to come to terms with Obamacare and extend Medicaid coverage to hundreds of thousands of Georgians who lack health insurance.
But this time, the critical arguments will be made not by Democrats, but by Republicans who will contend that, like it or not, the Affordable Care Act is a fact on the ground that is not going away. Human life isn’t the only thing at stake, they will argue. So is the economic life of the state. Jobs, jobs, jobs.
“Some Georgians think the federal health care law is great. Just as many think it’s terrible. But we all agree that health care is important to our economy and to families,” said Brian Robinson, who until a few months ago was the chief spokesman for Gov. Nathan Deal.
Yes, this is the the same Brian Robinson who tapped out press release after press release justifying his boss's opposition to the "huge financial burden" that a fully implemented Obamacare would place on his state. Now Robinson speaks of chasing "our" tax money that is going elsewhere.
If Republican politicians ever make good on their promises to repeal and replace Obamacare, Georgia will no doubt participate, Robinson said. But until then, there is the reality that many of this state’s hospitals are dying. And where they die, so does economic development. Take, for instance, the loss of Hutcheson Medical Center.
“This greatly hinders the state’s hopes of ever bringing another industrial or IT firm or any other major employer into that area. It really hurts those efforts,” Robinson said. “All those jobs move to Chattanooga, at the closest.”
The problem is not health insurance per se. It is the disappearance of health care providers whose funding mechanisms are drying up. If you have a stroke and are two hours from the nearest treatment center, it matters not whether you have insurance. You have been pierced by a spirally grooved, inclined plane. Metaphorically, speaking.
We were in a booth at a Buckhead diner, eating breakfast, when Robinson made this last point. With us was Blake Fulenwider, who was Deal’s health policy adviser when he was in Congress. Then health policy adviser for Deal when he was governor. When Fulenwider exited the administration, he was deputy commissioner for the Department of Community Health, which oversees Medicaid in Georgia.
Even before the ACA passed Congress, when Deal needed Obamacare numbers crunched, he called Fulenwider.
Both Robinson and Fulenwider are now part of a Georgia Chamber effort to find a “Georgia-specific solution that fits within the federal framework.” In other words, a relationship with Obamacare that is both financially sustainable and politically digestible by a state GOP that has vilified the program for the last five years.
Over eggs, both men emphasized that they are acting independently of their old boss. No winks or nods are involved, they said. But it is no coincidence that both Robinson and Fulenwider have served as trusted aides to the governor who would cut any deal with Washington — if there is a deal to cut.
Other red states are also coming to the realization that the best opportunity to repeal Obamacare died with Mitt Romney’s defeat in 2012. Control of both the White House and 60 votes in the Senate would be required — a bar that inches higher every day that Donald Trump dominates the 2016 Republican presidential contest.
Last week, a task force created by Gov. Robert Bentley, a longtime foe of Obamacare, recommended that Alabama expand its Medicaid rolls. Bentley is considering it. “I am concerned about the plight of the working poor,” he said.
A state possessing a well-insured workforce, and sitting side-by-side with another state that doesn’t, is likely to have an advantage when it comes to industrial recruitment. But there is more to Bentley’s assessment than that, or the financial situation faced by poorly paid working stiffs.
This was the Alabama governor’s back-handed recognition of the problem that continued opposition to Obamacare has created for Republicans. Those deprived of insurance coverage are often white, blue-collar workers. The Republican base.
In Kentucky, Gov.-elect Matt Bevin is pondering how he’ll keep his promise to repeal the Medicaid expansion enacted by his Democratic predecessor. A Kentucky political scientist has underlined the Republican’s dilemma: Bevin’s biggest margins came in counties with the highest levels of new Medicaid enrollees.
In Georgia, Robinson, Fulenwider and the rest of the Georgia Chamber intend to draw up two or three alternatives to have ready when — and if — the state’s Republican leadership alters course. Mark your calendar for January 2017.
Georgia is under two deadlines. “There’s a big hammer that’s hanging over every state,” Fulenwider told me. With the expectation that states would participate in Medicaid expansion programs, the ACA — as written — calls for the gradual elimination of extra federal funds targeted for hospitals that serve large numbers of indigent, non-paying patients.
Hospitals in most red states — without expanded Medicaid rolls that, elsewhere, now shoulder much of the cost of indigent care — are sweating the day those cuts come home. As of now, they would begin taking effect in 2018.
“We’re on the third [congressional] delay of implementation of those cuts, with a cliff that is getting deeper and deeper every year,” Fulenwider said. Any state without a plan in place when that cliff is reached is in for tough times.
In Georgia, the disappearance of hundreds of millions of federal dollars could send hospital after hospital into the red. Rural areas would be hit hard, but so would major trauma centers such as Grady Memorial in Atlanta and Memorial Hospital in Savannah.
Next year is an election year with a hot GOP presidential contest. Definitely not the right climate for negotiating a truce with Obamacare. No, Georgia’s political deadline is also 2018. And the next contest for governor.
A large Republican field would greatly appreciate it if this matter were settled before their many campaigns go into overdrive. That leaves 2017, when a governor in the final two years of his tenure might be asked to preside over the bipartisan coalition that would be required for the effort.
Just as happened during the last session of the Legislature, when an alliance of Republican and Democrats, pushed by a desperate business community, tackled the problem of funding for Georgia’s roads and bridges.
The difference is that, with Obamacare, there may be so much more to unsay.
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