Maggie Gill, president of Memorial Health in Savannah, told a temporary committee of lawmakers and gubernatorial appointees that the federal Affordable Care Act known as “Obamacare” was designed with the expectation that every state would expand Medicaid to cover people with higher incomes. By not expanding it, an estimated 600,000 Georgians will earn too little to buy taxpayer-subsidized insurance through health exchanges but too much to qualify for Medicaid.
Since Congress expected states to expand Medicaid, it is eliminating indigent-care payments to hospitals like Memorial that treat mostly uninsured patients. That will grow to a $20 million annual gap between the cost of treating them and what Memorial expects to receive by 2018.
“I guess the bottom line is if we don’t expand Medicaid and they cut the (hospitals’ federal subsidy) that are baked into the cake of the Affordable Care Act continue to go through, we’re giving up current funding, and we’re giving up future funding,” she said. “We’re putting hospitals like Memorial and other safety nets in a very tight spot.”
Small, rural hospitals are also in a pinch, according to H.D. Cannington, who was the CEO of Charlton Regional Hospital in Folkston until it closed last summer. It is one of three that closed this year, but as many as 20 are predicted to close in the next five years.
He recounted how just before the close, the hospital’s emergency room saved the lives of a mother and baby involved in a wreck. Then after the close, a woman suffered in the pain of being burned in an all-terrain-vehicle accident for 90 minutes while an ambulance transported her to a hospital in another town.
“Rural Georgians need rural healthcare,” he said. “Anything you guys can do would be appreciated.”
Dr. Jacqueline Fincher, who practices in Thomson, presented a more emphatic appeal.
“No. 1, you can be a hero by saving lives. No. 2, you can be a hero to the business community and expand economic development in Georgia, and No. 3, you can be a hero by finding a win-win solution for the state of Georgia,” said Fincher, the past governor of the 3,000-member Georgia Chapter of the American College of Physicians.
She urged the legislature to adopt Arkansas’ approach to Medicaid expansion in which the newly qualified are given taxpayer money to buy insurance from private companies on the health exchange rather than being covered by the state’s government-run plan.
Other witnesses had their own prescription, such as providing more coverage for mental-health treatment, paying off more of doctors’ student loans to convince them to work in rural areas, training more midwifes, funding clinics where doctors and nurses volunteer, and offering incentives to providers for better patient outcomes.
The committee members listened quietly because they had heard others make the same proposals. They really are hoping to find a lower-cost solution. State leaders are reluctant to expand Medicaid because they fear Congress’ budget cutting will leave the state having to pay most of the costs sometime in the future.
The committee will probably have another meeting or two before it writes a report for the governor and the legislature to consider when the General Assembly meets Jan. 13.
In the meantime, the committee members offered no clues Monday about what they will recommend.