Closing the Coverage Gap would benefit all Georgians, not just the uninsured

A number of rural hospitals in Georgia have closed in the last few years forcing many residents to travel long distances to get the health care they need. At the same time, federal money that most hospitals and clinics rely on is set to begin drying up in two years, increasing the financial pressure on the remaining providers. Governor Deal and the Georgia legislature would be wise to protect the health of Georgians by accepting billions of dollars from the federal government to keep rural hospitals open, maintain patient access to crucial health services, and stimulate the economy.


Georgia has the second highest uninsured rate in the country with nearly 1.4 million Georgians paying out-of-pocket for health care. More than 300,000 of these people fall into the “coverage gap” — making too little money to qualify for federally subsidized private insurance, but too much to receive Medicaid. When a life-saving drug can cost $86,000 per treatment, it’s easy to see why many Georgians are driven into debt. In fact, medical expenses account for 62% of personal bankruptcies nationally, according to a 2007 Harvard University study. Faced with this prospect many choose to delay or forgo care entirely, decisions costing Georgia 1,700 lives each year.

It’s no wonder then that Georgia’s rural hospitals, which serve a large number of uninsured patients, are feeling the squeeze. Since 2016, six hospitals have closed. Two of them were designated “safety-net” hospitals because they were uncompensated for more than 10% of the care they provided. At least 15 more are at-risk of closure and many have been forced to cut services to remain open.

These reductions in services will have real consequences for the lives of Georgians, potentially for generations. For example, many rural hospitals have closed their labor and delivery units leaving more than 40 counties without a practicing obstetrical doctor. Women in these areas often have to drive 30-40 minutes for prenatal check-ups and to deliver their babies in the care of an Ob/Gyn doctor. Faced with these obstacles, many women may be forced to forgo important prenatal care. With the possible spread of the Zika virus through the Southeast, the lack of these services could have real health consequences for families.

Injecting billions into our health insurance system would help meet these needs, and it makes financial sense. The federal government reimbursed Georgia’s hospitals and clinics $292 million this year for care provided to uninsured patients. However, this money will be phased out beginning in 2018, leaving Georgia’s providers and taxpayers on the hook for the bill. The Grady Health System, our State’s largest safety-net hospital, is set to lose about $45 million per year — nearly double the amount the taxpayers of Fulton and DeKalb counties are already shouldering to cover uncompensated care. A significant chunk of the loss of these funds could be offset by accepting the billions of dollars being offered by the federal government to give more than 300,000 eligible Georgians a way to pay for their care.

Every fiscal review of the 32 states and the District of Columbia that have closed the coverage gap has found a net-positive effect on the budget. The Kaiser Family Foundation estimates that closing the gap would support over 70,000 jobs. Furthermore, for every $1 Georgia spends on healthcare, the federal government would provide about $8 more, according to the Urban Institute. Republican governors in Ohio, Michigan, Indiana, Kansas, Florida, Alaska, Tennessee, Utah, and Wyoming have either accepted federal funds to close the gap or publically supported doing so in their states. Georgia Chamber of Commerce business leaders came to the same conclusion and are joining in the call to close the gap. But the Republican-controlled legislature in our state refuses to do so.

Republican Governor John Kasich of Ohio said, “when you die and get to the meeting with Saint Peter, he’s probably not going to ask you much about what you did about keeping government small, but he is going to ask you what you did for the poor. You better have a good answer.”

Accepting the billions of dollars available to us is not only fiscally responsible, it would deeply reflect our morals.

At Grady Memorial Hospital in Atlanta this Friday, patients, health care providers, students, and advocates are rallying for closing the gap. I support them, and I call on Governor Deal and the Georgia legislature to support them as well by protecting Georgian’s access to care, stimulating our economy, and saving lives.



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