- Jay Bookman The Atlanta Journal-Constitution
Rural Georgia is in deep trouble, and the attention now being paid to its challenges by state leadership is long overdue.
Lifespans are shrinking; jobs are disappearing. Rural hospitals are struggling to keep their doors open, and health-care professionals and the network they sustain are evaporating. The opioid epidemic is taking a heartbreaking toll, particularly among young men.
Overall, Georgia is one of the fastest-growing states in the country, yet roughly half of Georgia counties are losing population. Those who are fleeing are the young, the talented and the educated, leaving behind a workforce that is far less likely to attract employers.
It’s a slow-moving crisis, and judging from the rhetoric of legislative leaders and Gov. Nathan Deal, they’re ready to step up and try to help.
Except, not really. State leaders are talking about a variety of efforts, such as extending high-speed Internet service to rural communities. They have also proposed the idea of using the tax code to reward those who move to rural areas — basically, the state will be paying people to live there — but that’s of dubious effectiveness and opens a door to use of the tax code that probably ought to stay shut.
But without a doubt, the single most important step that state leaders could take to address the problems of rural Georgia would be to expand Medicaid coverage through the Affordable Care Act. Unfortunately, it’s also the one thing they have said they will not consider.
Medicaid expansion would help rural hospitals stay afloat, and without those hospitals, no tax incentive would ever be large enough to encourage people to move to or retire in those communities. It would finance treatment for drug addiction. By providing insurance to hundreds of thousands of Georgians, it would create and sustain thousands of jobs in small communities across the state and enhance the quality of life in rural areas.
This is not some secret. Everybody knows it. Economic development experts know it. Health-care leaders have been telling that story to elected officials for years now. And while state leaders claim we can’t afford the additional cost, projections show that the billions of dollars in federal resources that would pour into Georgia through Medicaid expansion would largely offset any additional state cost.
The problem, then, isn’t economic or fiscal. It is political. This is an election year, a year in which we choose a new governor and lieutenant governor, setting off a statewide game of musical chairs. Republican hopefuls for higher office have GOP primaries to win. And for all their expressions of concern for rural Georgia and the voters who live there, their higher priority is personal.
So, maybe next year?
Well, this year it’s 2018. The Affordable Care Act was enacted in 2010. Medicaid expansion became operational in 2014. Georgia is one of 18 remaining states that have not accepted expansion, and it has one of the highest uninsured rates in the country. The experience of other states — including Southern states — tells us that the benefits of expansion would be particularly compelling in rural regions, where employer-provided insurance is more rare.
But out of sheer cussedness and political calculation, we are forbidden to reap those benefits here.