SANDRA REED/LEN LICHTENFIELD: Expanding Medicaid would boost shrinking rural economies

In Georgia – as well as in the rest of the nation – there’s a stark divide between metropolitan areas and rural counties. There’s growing disparity in wealth, education attainment and even health.

Governors and legislators have for years tried to close the gap with additional incentives for economic development in rural counties, technical college programs and infrastructure projects such as the current focus on expanding broadband access.

These are visionary and appreciated efforts. Broadband particularly has the potential to attract professionals looking for a lower cost of living, no traffic and the charm of small-town life where you can enjoy a sense of community. The past year of virtual work has seen many flee the hustle and bustle and crime of big cities.

Yet, for now, only a handful of Georgia communities – particularly those with an interstate — are well positioned to take advantage of that opportunity and most of rural Georgia is still falling farther behind.

Before we can even begin to move rural Georgia forward, we have to stabilize its economy, and we can’t do that as long as those counties continue to lose their health care access points. Just as we would treat a wounded patient, we have to stop the bleeding before we can turn our attention to rehabbing the injury.

Since 2008, 10 rural hospitals in Georgia have closed, with north and south Georgia taking major hits. southwest Georgia has suffered the worst. One southwest Georgia state House district – out of 180 statewide – has lost three hospitals in the past decade. This includes Southwest Georgia Regional Medical Center in Cuthbert, which closed in October.

This hits close to home for us because we both practiced medicine in southwest Georgia for many years.

These closures can cause a spiral. First, these communities lose high-paying jobs and part of their tax base. Local businesses shutter, and property values decline. With dim prospects, those with education and wealth move away. It becomes impossible to bring in new industry because good employers aren’t coming to a region where their work force can’t get access to emergency health care.

Rural hospitals are taking hits from several directions. First, hospitals must serve everyone, regardless of ability to pay. Hospitals in areas where many are uninsured provide significant levels of uncompensated care. Second, hospitals that serve a high level of nonpaying patients used to get federal payments to make up some of the difference. Those payments went away once the Affordable Care Act took effect because the law assumed that Medicaid expansion would greatly reduce the levels of insured.

But Georgia didn’t expand Medicaid, leaving hundreds of thousands uninsured and hospitals in worse shape than ever.

Expanding Medicaid wouldn’t solve every problem with rural health care, but it would inject hundreds of millions of dollars each year into our health care system – money that we pay in federal taxes that go to other states but not here.

This would bring jobs and economic development, in addition to a healthier population, throughout rural Georgia. Republican opposition to expanding Medicaid has lessened greatly in recent years, and that’s perhaps because it would greatly help the rural counties that today is home to significant portion of the GOP’s base vote. Some counties in north Georgia that have lost hospitals gave Gov. Brian Kemp 90 percent of their votes in 2018.

Rural Georgians, Republicans and Democrats alike, would gain the biggest benefit from Medicaid expansion. It would help the uninsured by providing coverage and preventative care they couldn’t afford before, and it would help those with health insurance, too, because it means their local hospital and other providers can stay open.

There’s never been a better time than now to expand Medicaid because recent federal legislation has incentives for the handful of states – we’re one of only 12 – that haven’t done so yet. Though the federal government normally pays 90 percent of the cost, with the state picking up the other 10, for the next two years the federal government would cover the entire cost.

That’s hundreds of millions of dollars we’re currently refusing to take that would flush into the shrinking economies of rural Georgia. With the incentives now in place, Republicans have a strong economic case to make for coming out in support of this change, and with counties that give the GOP its highest level of support losing population every day, they have a strong political argument for it, too.