They thought it would not matter. Their families have good insurance, excellent financial health and perhaps they have friends who are physicians or even hospital administrators. These elected officials and their advisors thought that expanding Medicaid was unnecessary.
They did not personally know the 400,000 people in Georgia affected by lack of access to care who were suffering from hypertension and diabetes resulting in strokes, heart attacks and kidney failure. Their families were not on dialysis because they could not gain access to antihypertensive medications that were free at the grocery store but required a physician’s prescription to access.
Things have changed.
Whether you own a large corporation, are an elected official, or even if you are a physician, it will be extremely difficult to access advanced emergency or hospital-based medical care in the north central region of Georgia.
On a day in the last week, almost every hospital in this region was on some type of diversion due to overwhelming volume, complicated by personnel shortages. The recent closure of Wellstar hospitals’ inner city medical centers will result in over 100,000 patient emergency visits a year going to other facilities. The other hospital beds and emergency facilities are already full. Exploding waiting times and ambulance diversion will make access to hospital-based medical care extraordinarily difficult in the Atlanta region -- for everyone.
Trauma cases seem to gather the most publicity. There were only two Level 1 trauma centers in this region: Grady and AMC. The expert trauma team at Wellstar Atlanta Medical Center will no longer receive patients. Grady is full most days. Wellstar Kennestone is a very large Level 2 trauma center, but is more than 20 miles from downtown Atlanta. There are two more Level 2 centers and three Level 3 centers in the region.
Other hospitals divert cases or transfer to trauma centers. On some days, that may not be possible.
As an emergency physician, I am afraid for my patients. The waiting rooms are overflowing. Transfers are exceedingly difficult. Pediatric hospitals are not affected by this, but the other hospitals are.
The Georgia Coordinating Center has a website (https://georgiarcc.org/) that shows the availability of hospital and emergency beds throughout Georgia. Every evening of late, almost all of the non-pediatric hospitals in north central Georgia were on a type of diversion or were rated “severe” by the National Emergency Department Overcrowding Scale (NEDOCS) score, which reflects overcrowding in emergency departments. Terms such as psych diversion, medical diversion, total diversion, ICU diversion, STEMI (acute heart attack) diversion, medical saturation, ICU saturation, labor and delivery diversion, ER saturation and ER diversion are common and posted every day.
Elected officials who rejected the expansion of Medicaid in the state of Georgia chose to refuse more than $3 billion a year of federal funds intended for medical care since 2014. Imagine trucks loaded with money stopped at the state border. The legislature even voted to prevent a sitting governor from allowing Medicaid expansion without their support. The state of Georgia could have benefited from this massive infusion of funds: Expanded access to care, access to prescriptions for hypertension and diabetes and more financially healthy medical centers.
Now we are dealing with the closure of 8 hospitals in rural Georgia and finally 2 more in central Atlanta. Hospitals are hurting financially due to uncompensated care and an increased cost of labor.
An extra $3 billion a year could not hurt.
Decision makers who block medical funding and care seem indifferent to those who need it. Those who had the power to deny expansion and the associated federal funding were certain that this would never affect them and that their families would not suffer.
Medical systems and access to care are all connected. Perhaps when the hospitals that closed were in southwest Georgia it did not affect the families of the decision makers in the greater Atlanta region.
That is no longer true.
I fear for the families who cannot access timely care. Paramedics drive many miles with acutely injured patients seeking care in trauma centers. That access has now been greatly depleted. The same will be true for strokes, complications of pregnancy and cancer and heart attacks.
You have heard some refer to this as a medical catastrophe. This is true. Perhaps with creative planning, some of the impact can be averted.
I am not certain that the people of this state are aware of the consequences of these decisions and policies.
They will soon find out.
Hank Siegelson, M.D., is an emergency physician of 40 years’ experience in Atlanta.
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