April 17, 2019 Atlanta - Karen Sutton (left), Licensed Clinical Social Worker (LCSW), and Dr. Claudia Vellozzi (center), medical director Chronic Care Clinic, confer as they look medical files of Alex Harris (right), who is a Chronic Care Clinic program participant, at Grady Memorial Hospital's Chronic Care Clinic in Atlanta on Wednesday, April 17, 2019. The Chronic Care Clinic is unique in that it's got not just a doctor and a nurse and assistants, but community health workers who get deeply involved in the patient's situation, a social worker who hooks them up with resources, a behavioral health clinician who addresses addiction and mental health issues, and a highly credentialed pharmacist. HYOSUB SHIN / HSHIN@AJC.COM
Photo: HYOSUB SHIN / AJC
Photo: HYOSUB SHIN / AJC

Atlanta Democratic debate: The major issues in Georgia

Democratic presidential candidates will face wide range of questions at next week’s debate in Atlanta. 

Here’s a look at the key issues in Georgia and how they impact residents. 

Criminal justice

Georgia gained national attention while Republican Nathan Deal was governor for his criminal justice initiatives. Those efforts, passed with overwhelming bipartisan support, steered more nonviolent criminals away from prison and toward accountability courts and other programs. Under Deal’s guidance, more state funding and resources poured into rehabilitation programs, and judges were given new flexibility for sentencing for some crimes.

The last criminal justice bill that Deal signed into law in 2018 required judges to consider a defendant’s financial status when setting bail, and it allowed law enforcement officers to issue citations instead of filing criminal charges. The efforts under Deal helped cut Georgia’s prison admissions by 18.6% between 2009 and 2017. The incarceration of black inmates fell by 30%.

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A change in administrations could mean a step back for some of the initiatives that passed under Deal.

Brian Kemp succeeded Deal after campaigning to get tough on violent crime. He signed several measures this year that aim to curb sex trafficking and poured more resources into programs targeting street gangs. He’s also ordered state agencies to cut spending by $200 million during this fiscal year and $300 million next year.

The state Department of Corrections may take the biggest hit under Kemp’s order. Hundreds of positions in the department have been identified for RIFs, or reductions in force, in areas such as construction, food services, administration and education. Some could result in layoffs, and others would be transferred to new jobs. Also marked for big pay cuts are some teachers who help inmates transition back into society.

The economy

Overall, Georgia’s economic outlook appears to be good. It’s even better for metro Atlanta.

In October, the state reported adding 77,400 jobs during the past year.

Georgia’s unemployment rate was 3.5% in September, the same as the national average. That represented a long climb for the state, which was hit harder than most of the nation during the housing crash and Great Recession, causing Georgia’s jobless rate to exceed the national average for years.

Metro Atlanta’s unemployment rate fell to 2.9% in September, the lowest it’s been since late 2000. The region has added 53,100 jobs in the past year, more than 16 times as many as any other metro area in Georgia.

Future economic trouble is always possible, though. The trade war with China could worsen, and interest rates might rise, chilling the housing market. Big companies, for any number of reasons, could cut back on investments, and the impact could ripple through the state’s economy.

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Georgia’s fiscal economist predicted in September that there was a 50-50 chance of a mild recession occurring next year, and that helped support Kemp’s order to cut $500 million in state spending over the next year and a half, in part as a hedge against an economic downturn.

The state’s poverty rate of 14.7%, while improving, also remains higher than the national average of 12.3%.

Trade

Trade is an issue of utmost importance to Georgia, with major ports located in Savannah and Brunswick.

A March 2018 study by the University of Georgia found that maritime trade accounts for $44 billion of the state’s gross domestic product and that the ports directly or indirectly touch more than 439,000 jobs. About half of them are based in metro Atlanta.

In August, the Port of Savannah saw its biggest month ever for container traffic. That growth came even as trade tensions rose between the U.S. and China and amid signs of softening global demand.

Fallout from the trade war with China has hit Georgia’s largest industry: agriculture.

Crops that have been targeted for Chinese tariffs include cotton, peanuts, pecans and soybeans.

The Trump administration accuses China of keeping its markets closed to foreign goods, such as a ban on U.S. chicken imports. That has huge meaning for Georgia, the nation’s biggest poultry producer.

But that’s not the only trade front that affects Georgia agriculture.

The U.S. Mexico Canada Agreement, a reboot of the North American Free Trade Agreement still waiting for congressional approval, has divided the state’s farmers.

Favoring the new trade proposal in Georgia are the growers of crops such as cotton and peanuts, those who raise chickens and others who produce wood pulp.

But others oppose the USMCA, including Georgia Agriculture Commissioner Gary Black and farmers who grow seasonal produce such as blueberries, peppers, squash and tomatoes. They say NAFTA allowed cheap Mexican imports to drive down their prices, and the USMCA does not do enough to remedy that.

Guns

Gun rights advocates have made significant gains in Georgia in recent years with the help of the state’s Legislature.

A 2014 law gave Georgians the ability to carry firearms in a wide range of new places, including schools, bars, churches and government buildings. Three years later, another law allowed people who hold firearms permits to carry concealed weapons onto public college and university campuses.

Gun rights advocates have experienced a few setbacks, although those efforts will likely be renewed.

One is legislation that would allow Georgians to carry weapons without a permit. Such a bill made little headway in the General Assembly during this year’s legislative session, though Kemp and other Republican leaders have expressed support for the idea.

Gun control efforts in the Legislature have generally fallen short of passage.

That includes a Georgia version of “red flag” legislation that would allow authorities to take guns from people who pose a danger to themselves or others. It never received a vote in the Republican-controlled General Assembly, even though President Trump endorsed the idea at the federal level.

Neither did a Democratic-backed proposal that would keep guns out of the hands of people convicted of family violence.

And Democratic efforts to ban assault weapons have gone nowhere.

Federal law bans people from buying guns if they have been involuntarily committed for mental health treatment. But Georgia lawmakers found a way to stymie that law by passing their own measure more than a decade ago requiring the state to purge those records after five years.

Recent Atlanta Journal-Constitution polling has shown state voters favor some restrictions on gun owners.

In January, 78% of voters backed an increase in the minimum age for purchasing an assault weapon in Georgia from 18 to 21. A slightly larger group, 82%, opposed allowing gun owners to carry concealed weapons without a permit.

Health care

Georgia is in a state of flux when it comes to health care.

Gov. Brian Kemp just presented a pair of proposals earlier this month seeking federal health care waivers that would overhaul the individual health insurance market in the state and provide for a limited expansion of Medicaid.

The market proposal would set aside more than $300 million in public money to pay to insurance companies to cover high-cost claims in an effort to lower premiums. The proposal would also give the state control over $2.7 billion in federal subsidies that reduce costs for lower-income policyholders.

The Medicaid proposal, Kemp’s aides said, is projected to enroll about 50,000 of the 408,000-some Georgians who make less than the federal poverty level of just over $12,000 a year for an individual.

The consulting firm Deloitte conducted a study Kemp used in forming his proposals, and it found that if Georgia fully expanded Medicaid as prescribed under the Affordable Care Act at 138% of the federal poverty line, about 666,000 Georgians would have qualified for coverage.

Kemp’s Medicaid proposal also includes a requirement that recipients either hold down jobs, go to school or job training, or engage in specific types of community service or volunteering. Such requirements have not fared well in court challenges.

Each proposal would require approval from the federal government before it can be implemented – no certainty despite Kemp’s ties to Trump.

As part of its work for the waivers, Deloitte painted this picture of health care in Georgia:

     
  • 14.8% of the state’s residents, according to a running five-year average, are uninsured, compared with 10.5% nationally.
     
  • 28.5% of the population living below the poverty line is uninsured – 478,000 people. The rate exceeds the averages for both states that have expanded Medicaid under the Affordable Care Act (20%) and states that have not (26%).
     
  • At roughly 27%, Georgia has the second-highest rate in the nation of young adults, ages 19-34, who are uninsured.
     
  • 8% of the state’s children have no insurance coverage. The national average is 5%.
     
  • Minorities are more likely to be uninsured than white residents. About one-third of Hispanics and 15% of African Americans lack health coverage, compared with 12% of white residents.

Deloitte also found that Georgia, at seven, trails only Texas and Tennessee in the number of rural hospitals that have closed since 2010. The consulting firm also reported that 26 of Georgia’s 63 remaining rural hospitals are at risk of closure.

The report also found that about half of Georgia’s 159 counties lack an obstetrician/gynecologist, and several counties have no doctor at all.

In terms of overall health outcomes, Georgia ranks 35th among the states.

Veterans’ care

Providing health care to military veterans has been an acute problem in Georgia, particularly at the Atlanta Veterans Affairs Medical Center in Decatur.

The 400-bed facility and its 15 satellite clinics, which serve about 120,000 veterans in the region, have endured a number of shake-ups in leadership. The most recent occurred in September after a cancer patient was found with more than 100 ant bites.

Last year, the U.S. Department of Veterans Affairs gave the hospital an overall quality rating of one star, placing it among the lowest 10% of the agency’s 100-plus medical centers in the nation.

The Atlanta VA Medical Center is part of the larger Veterans Integrated Service Network 7, which has also seen its share of troubles. The network, which oversees eight hospitals in Georgia, Alabama and South Carolina, received the lowest patient satisfaction scores of any of the country’s 18 regions.

The network also has problems with employee culture. Three of its hospitals, including the Atlanta VA Medical Center, rank among the nation’s four worst in employee satisfaction. In the past two years, employees in the region have filed 288 complaints with the VA inspector general, 43 of them alleging whistleblower retaliation.

Infrastructure

Nearly three years ago, some Georgia officials were confident that newly elected Trump and Democrats in Congress would cut a deal on a federal infrastructure bill. And they believed the state was in a good position to capitalize on such a deal.

Georgia had already raised its own spending on road and bridge construction by nearly $1 billion a year – demonstrating a willingness to match any new federal spending. And it was open to the kind of public-private partnerships the Trump administration favored.

Things haven’t worked out as Georgia officials hoped. There’s been no infrastructure deal. And, despite the additional state money, there are still unmet infrastructure needs. Among them: a need to expand roads and rail to accommodate freight out of the Port of Savannah and plans for a dramatic transit expansion in metro Atlanta.

Immigration

Illegal immigration remains an issue of high importance in Georgia, although the population of immigrants living illegally in the state appears to have declined.

An estimated 375,000 immigrants were living illegally in Georgia in 2017. That was down from a high of 425,000 a decade earlier, according to the Pew Research Center.

Among immigrants living in the state, about 21,600 have been accepted into the Deferred Action for Childhood Arrivals program, also known as DACA. That includes 15,700 in the Atlanta-Sandy Springs-Roswell metropolitan area.

The Obama administration created DACA in 2012 to grant temporary deportation deferrals and work permits to immigrants who were brought to the U.S. as children.

Trump tried to end the program in 2017, calling it an unconstitutional use of executive power. But the courts, including the U.S. Supreme Court, have rejected his efforts.

Courts in Georgia have been friendlier to Trump’s overall push against illegal immigration.

An Atlanta Journal-Constitution analysis found that the state’s two immigration courts had the second- and third-highest rates for denying requests for asylum between 2013 and 2018. The court in South Georgia denied 95% of the asylum cases it handled. The denial rate at the court in Atlanta was 94%. The national average was 58%.

Marijuana

Georgia has allowed the use of marijuana for medical purposes since 2015 in the form of an oil that contains no more than 5% THC, the compound that gives users a high.

However, there is a hitch: There’s no way to legally obtain the oil in the state to treat several illnesses allowed under state law, such as severe seizures and terminal cancers.

That has forced patients and their families to buy the drug through the mail, drive to other states or obtain it through friends. That has placed them in jeopardy because most states, as well as the federal government, make possessing marijuana a crime.

As a remedy, Georgia’s Legislature passed a bill earlier this year to allow the limited in-state cultivation of marijuana and manufacture of the oil. But before that could happen, Kemp, Lt. Gov. Geoff Duncan and state House Speaker David Ralston were required to name the seven members of a board to regulate medical marijuana in the state. Those appointments occurred earlier this month, nearly seven months after Kemp signed the bill into law.

In terms of recreational use of marijuana, legalization efforts in the state Legislature have gone nowhere.

Since 2016, however, at least 12 Georgia cities and counties have passed local laws reducing the penalty for possession of 1 ounce or less of marijuana. Nearly 1.2 million people, about 11% of the state’s population, now live in a place where, in most cases, they won’t be jailed if found with less than 1 ounce of pot.

Opioids

Georgia can claim a deadly share of the nation’s opioid crisis, with 873 fatal overdoses in 2018.

That, however, marked an improvement from 2017, when the state experienced 996 deadly overdoses.

The state saw some other hopeful signs. The Georgia Department of Public Health reported that the number of prescriptions in the state for opioids such as hydrocodone and oxycodone dropped by 13% between 2016 and 2018.

A national trend, however, has been that after addicts can no longer get prescription opioids they turn to street drugs for other opioids.

In a lawsuit the state filed against more than two dozen makers and distributors of opioids, it claims that 180,000 Georgians have an opioid use disorder. The suit adds that the opioid epidemic has foisted a range of expenses on the state, including increases in addiction treatment, the treatment of associated illnesses, the burden on policing and jails, and the increased need for foster care. Georgia does not ask for a specific dollar amount in the suit.

The state says the companies engaged in a range of illegal activities, including misleading people about the addictive nature of the drugs and not taking the preventive action that the law requires. The companies counter that they are not responsible for what individual drug abusers and unethical prescribers did further down the pipeline.

Purdue Pharma, the maker of OxyContin, was dismissed from the suit after declaring bankruptcy, and Georgia has joined 23 other states in accepting a settlement with Purdue that the company says could be worth $10 billion or more. Others dispute that figure.

In a separate suit, more than 80 Georgia cities, counties and hospitals have joined about 2,000 tribes and local governments from across the nation in suits that have been consolidated under one judge in Ohio.

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