Spooked by a spate of recent hospital closings in rural Georgia, state leaders on Wednesday embraced a rewrite of healthcare rules aimed at keeping faltering facilities open.
Gov. Nathan Deal’s plan would allow rural hospitals to dramatically scale back their services if they are in danger of closing or if they’ve shut their doors in the last year. The goal is keep these healthcare facilities afloat as they struggle for funding amid high unemployment rates and stagnant population growth in struggling areas.
The changes only apply to facilities within 35 miles of a full-service hospital. They would be allowed to convert into a freestanding emergency room that can stabilize patients and transfer them to nearby full-service hospitals. The changes allow them to abandon other costly staples of hospital care, such as inpatient surgery and complicated child deliveries.
“Communities should not have to go without crucial services – many of them life-saving – simply because they don’t fall within a certain zip code,” said Deal, adding: “By eliminating the necessity of trying to staff a full-service hospital with beds that do not have patients, with staff they do not necessarily need, I think this will help hospitals to stay open.”
The plan earned bipartisan support from rural lawmakers and healthcare advocates. Yet several legislators warned that a more sweeping fix is needed to help sustain rural hospitals in the longer term, and contended that Deal’s decision to reject funding for Medicaid expansion under the federal healthcare overhaul only aggravated the situation.
“I see it as a good step in the right direction,” said state Rep. Debbie Buckner, D-Junction City. “A lot of what rural hospitals need is a steady cash flow. And I don’t know if these suggestions will lead to that.”
The fate of rural hospitals is a recurring theme this legislative session, which ends on Thursday. Four rural hospitals were shut down over the last two years, and four others have closed their doors since 2000. Healthcare activists worry more could be shuttered because of Deal’s rejection of the Medicaid expansion, which he views as too costly.
Republican state Rep. Sharon Cooper of Marietta revived the debate over how to bolster faltering rural hospitals in January when she said that some need to close and instead rely on regional hubs. She walked back those comments after fierce backlash, but her remarks underscored the ongoing struggle how to bolster rural hospitals.
Deal’s critics see a ready-made solution to the problems. They contend that that expanding Medicaid under President Barack Obama’s healthcare overhaul would add an estimated 650,000 low-income Georgians to the program’s rolls and a wave of new revenue for the hospitals.
“His plan is not even a small Band-Aid for a health care crisis that threatens the lives millions of Georgians,” said Bryan Long of Better Georgia, a progressive group that often needles the governor. “Cutting services in areas that are already suffering and creating a committee for simply more talk is insulting to the families who depend on these rural hospitals.”
Deal has made clear that expanding Medicaid in the state is a non-starter, and his office estimates it could cost the state $2.5 billion over a decade even with the federal government’s promise to pick up 90 percent of the tab after three years. He argued Wednesday that expanding Medicaid would not help rural hospitals because it’s a “cost-loser” that wouldn’t fund the full cost of medical services.
Rural hospitals that have already shuttered left behind devastated communities. Stewart-Webster Hospital in Richland closed last year after seeing only about 10 patients a day and about five surgeries a week. Patients who live in the southwest Georgia community are being diverted to larger hospitals in Columbus and Americus, both about 35 miles away.
Bonnie Witt, a county clerk who lives in Richland, remembers cutting her hand after a nasty fall about six years ago. Her terrified husband bundled her into the family car, hopped the curb outside the facility and rushed her inside to get stitches.
“I thought I was going to die. If I had to go anywhere besides Richland that day, I don’t know what I would have done,” said Witt, a 56-year-old who was born and raised in the community. “I was going to that hospital all my life. It hurt us really bad when it closed. And I miss it. Everyone does.”
State Rep. Terry England, who advised Deal on the plan he unveiled Wednesday, said shuttered hospitals give potential employers a reason to go elsewhere.
“If companies come to look at rural Georgia, they look at access to rural healthcare for their employers,” said England, an Auburn Republican who chairs the House’s budget-writing committee. “And you take those rural hospitals out of the mix, that has a crippling effect on those local communities in attracting industry. It’s not a deal-breaker but it’s important for quality of life.”
The governor will also assign a state health employee to serve as liaison to rural hospitals who will alert the state if any are in danger of closing. And he’ll tap a committee to come up with legislative recommendations aimed at rural hospitals. The plan doesn’t require legislation, and is expected to soon be approved by the Department of Community Health.
Some Democrats and advocates hold out fleeting hope that Republican leaders have a change of heart over the Medicaid expansion, despite anti-Obamacare laws approved in the session’s final days aimed at snubbing the federal overhaul.
“Anything we can do to keep that cash flow where it is will help,” said Buckner, the Democratic lawmaker. “I believe that Medicaid expansion would help kick the can down the road and infuse cash to keep those hospitals going. It may not be the solution, but it would help in the short term while we come up with a long-term fix.”