That rural hospitals need a financial shot in the arm is no secret. At least seven have closed in Georgia since 2010. They have faced a squeeze in reimbursements for Medicare and Medicaid patients; too many people using expensive emergency rooms like their personal clinic; and poor, aging and often declining populations.
After the General Assembly approved the program in 2016, it gained some ill will from top lawmakers when a consultant began signing up rural hospitals to help them raise money. That meant a percentage of the donations intended for struggling hospitals would wind up being paid to the consultant, who maintained that the hospitals didn't have the infrastructure to raise the money.
Most of the more than 50 rural hospitals eligible to receive the donations signed up with the consultant.
Some rural hospitals have benefited. Officials at Evans Memorial Hospital in Claxton told The Atlanta Journal-Constitution last fall that they raised $543,000, most of it from a local company that wanted its donation to remain anonymous.
They said much of the donation money went to improving surgical and imaging services.The hospital was able to buy equipment that allowed it to expand highly reimbursed procedures, such as ERCP tests that check ducts that drain the liver, gallbladder and pancreas. That, in turn, has made it easier to attract patients.
Lawmakers decided this session that they needed to do more to entice donors.
"We think the reason the tax credit didn't raise more is we didn't go to 100 percent," said state Rep. Trey Kelley, a Cedartown Republican and the sponsor of House Bill 827, the expanded tax credit bill.
At 70 percent, a $100 donation allowed donors to take $70 off their taxes. Under HB 827, $100 would mean a $100 credit against taxes.
However, some Democrats, led by state House Minority Leader Robert Trammell, D-Luthersville, voted against Kelley's bill. They said it wasn't because they didn't support the idea. They just think Republicans have ignored what they see as the best way to solve the rural hospital crisis: expanding Medicaid under Obamacare, as many other states did.
Trammell said the Republican majority’s decision not to expand Medicaid — with most of the money coming from the federal government — is costing Georgia hospitals $3 billion a year.
“Every dollar we can get into rural hospitals is important,” Trammell said. “The No. 1 thing we could do for rural hospitals and uninsured Georgians is talk about the possibility of expansion (of Medicaid.)”
Gov. Nathan Deal and Republican leaders have generally opposed expanding Medicaid, which provides health coverage for the poor, disabled and those in nursing homes. Deal has repeatedly said the state can't afford the matching money needed for expansion. Critics say the state could afford it if lawmakers slowed the yearly parade of special-interest tax breaks they dole out.