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By now, millions of Americans—most of them in red states—are growing familiar with the "coverage gap." Thanks to their rejection of the Affordable Care Act's expansion of Medicaid in states they control, GOP leaders are leaving at least five million people in an insurance "dead zone," earning too much to qualify for Medicaid but too little to obtain federal subsidies to purchase coverage on their own. As a recent Harvard study suggests, that Republican dead zone is a very real body count, with as many as 17,000 people forecast to needlessly die each year due to lack of health insurance.

But GOP obstruction won't just kill people in places like Texas, Mississippi and many more. As the case of Georgia shows—where over 600,000 residents will fall into the coverage gap and as many as 1,175 will die this year—Republican policy is killing hospitals, too.

As ThinkProgress reported, a fourth rural hospital in Georgia is shutting its doors due to a lack of patients who can pay for their medical expenses:

The Lower Oconee Community Hospital, a so-called "critical access" hospital in southeastern Georgia with 25 beds, will close down and possibly re-open as an urgent care center that provides services that aren't quite serious enough to necessitate an emergency room visit. Patients in the Wheeler County region who need more extensive medical care after the hospital closes will need to travel upwards of thirty miles in order to receive it.

"We just did not have sufficient volume to support the expenses," said CEO Karen O'Neal in an interview with local CBS affiliate WMAZ. "It's a terrible situation, and it's tragic, the loss of jobs and the economic impact."

Please read below the fold for more on this story.

It's tragic all right. And as with many facilities in rejectionist red states, it doesn't have to be this way. Because it's not just millions of their constituents who are falling into the Republican coverage gap. As Bloomberg and CNN recently documented, many of the hospitals, clinics and emergency centers that serve them are at risk, too.

In GOP Governor Nathan Deal's Georgia, it's not just Lower Oconee Community Hospital facing a possible death sentence. As the New York Times reported in November, Memorial Hospital in Savannah, Georgia, "is now facing the loss of nearly half of its roughly $100 million in annual subsidies known as disproportionate share hospital payments." The Times explained how the Republican temper tantrum after the Supreme Court made Medicaid expansion optional for the states is putting red state hospitals at risk:

Now, in a perverse twist, many of the poor people who rely on safety-net hospitals like Memorial will be doubly unlucky. A government subsidy, little known outside health policy circles but critical to the hospitals' survival, is being sharply reduced under the new health law.

The subsidy, which for years has helped defray the cost of uncompensated and undercompensated care, was cut substantially on the assumption that the hospitals would replace much of the lost income with payments for patients newly covered by Medicaid or private insurance. But now the hospitals in states like Georgia will get neither the new Medicaid patients nor most of the old subsidies, which many say are crucial to the mission of care for the poor.

Savannah Memorial has plenty of company in Georgia, where Governor Deal said no to $33 billion in new federal Medicaid funding over the next decade. But as the federal government significantly reduces funding on Disproportionate Share Hospital (DSH) payments for the care of the uninsured, states like Georgia which turned down Obamacare's Medicaid dollars will be on the hook to make up the difference. For Grady Memorial Hospital, the largest in the metro Atlanta area, what could have been an annual boon of $60 million and coverage for 27,000 uninsured patients instead will be a $45 million loss. Georgia taxpayers will have to pay more even as hospitals likely cut services. Meanwhile, three cash-strapped rural hospitals have already closed their doors. Another 15 may follow suit in 2014. All because a Republican Governor said "no" to free money from Washington, DC.

And the funding really is virtually free to the states.

The federal government will pay for 100 percent of the cost of the Medicaid expansion until 2017 and 90 percent after that. The loss to rejectionist red state coffers, the Commonwealth Fund found, is staggering. As USA Today summed it up:

By 2022, Texas could lose $9.2 billion by not expanding Medicaid as allowed under the Affordable Care Act, while Florida could lose $5 billion over that period, the study conducted by The Commonwealth Fund shows...Also during that period, the study showed, Georgia could lose $2.9 billion, while Virginia could lose $2.8 billion.

"There are no states where the taxpayers would actually gain by not expanding Medicaid," said Sherry Glied, lead author on the study. "Nobody wins."

But the billions the "opt-out" states will have to come up with in future years will be more than offset by their extra costs to compensate hospitals and other providers for the care of the uninsured. As Ezra Klein and Evan Soltas summed up in an analysis by the RAND Corporation of 14 Medicaid-rejecting states earlier this year:

It finds that the result will be they get $8.4 billion less in federal funding, have to spend an extra $1 billion in uncompensated care, and end up with about 3.6 million fewer insured residents.

So then, the math works out like this: States rejecting the expansion will spend much more, get much, much less, and leave millions of their residents uninsured. That's a lot of self-inflicted pain to make a political point.

Which is just one of the reasons why an increasing number of red state governors are accepting the dollars from DC. GOP governors in Michigan, Pennsylvania and Ohio ran the numbers. In Ohio, Governor John Kasich's decision to take Washington's money will actually produce a $400 million surplus for the Buckeye State (one which Republican legislators want to give away in the form of more tax cuts). The simple math and simpler consideration in insuring millions of indigent patients as the DSH funding is reduced over time is precisely why hospital associations in Texas, Kentucky, Georgia, Mississippi, North Carolina and every other state pleaded with Republican governors and legislatures to take Obamacare's money for Medicaid expansion. In October, the Fitch ratings agency released a special report titled, "Adverse Expansion: Hospitals, States and Medicaid," which warned that:
"Hospitals operating in states not expanding Medicaid, which usually have higher uninsured and poverty rates, will have to absorb the full impact of the ACA reimbursement cuts without the full benefit of increased insured volumes," said Adam Kates, Director in Fitch's Public Finance group. Texas, Florida, Georgia, Louisiana, Mississippi, and South Carolina are not expanding Medicaid and have among the highest uninsured and poverty rates, and some of the most stringent Medicaid eligibility requirements. Fitch believes hospitals in these states, particularly those with weak payer mixes, will be particularly vulnerable.
It's no wonder Arizona Governor Jan Brewer, certainly no friend of Barack Obama, explained her decision to extend Medicaid coverage to 300,000 more people in her state this way:
"It's pro-life, it's saving lives, it is creating jobs, it is saving hospitals."
But not in Georgia. And not in Rick Perry's Texas, Rick Scott's Florida, Phil Bentley's Mississippi, Scott Walker's Wisconsin or any other state where supposedly pro-life Republicans have essentially sentenced thousands of people to death.

Originally posted to Jon Perr on Tue Feb 18, 2014 at 03:09 PM PST.

Also republished by Kos Georgia.

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Comment Preferences

  •  The Emory hospitals are running ads (13+ / 0-)

    which essentially say, "We don't need no stinking government fixing our health care." I'm tempted to show up at the Shepherd Spine Center and ask them to fix my back. I'm fairly certain that they don't take TRICARE and would throw me out on my ear. So much for "We're all in this together."

    "The object of persecution is persecution. The object of torture is torture. The object of power is power. Now do you begin to understand me?" ~Orwell, "1984"

    by Lily O Lady on Tue Feb 18, 2014 at 03:30:46 PM PST

    •  Obviously they are in a wealthy area (2+ / 0-)
      Recommended by:
      Lily O Lady, mcstowy

      Rural community hospitals are going to be devastated by the failure to expand Medicaid. The Emory admins should be ashamed of themselves. They are killing poor patients.

      “Industry does everything they can and gets away with it almost all the time, whether it’s the coal industry, not the subject of this hearing, or water or whatever. They will cut corners, and they will get away with it. " Sen. Jay Rockefeller, D, WVa

      by FishOutofWater on Tue Feb 18, 2014 at 04:31:22 PM PST

      [ Parent ]

      •  Public hospitals like (1+ / 0-)
        Recommended by:

        Grady are being hurt as well right here in Atlanta, but I'm afraid Emory wouldn't mind absorbing Grady rather than just using it as a training facility for their med school.

        "The object of persecution is persecution. The object of torture is torture. The object of power is power. Now do you begin to understand me?" ~Orwell, "1984"

        by Lily O Lady on Tue Feb 18, 2014 at 07:05:28 PM PST

        [ Parent ]

      •  Don't watch tv so have not seen these ads (3+ / 0-)

        I know that the Emory University hospital system & clinics do treat the poor & those on Medicaid.

        My 18 year old child with special needs has been treated & followed by multiple specialists at both Emory & CHOA his entire life.  The only health insurance my child has had was the Katie Beckett Medicaid Deeming waiver and now (due to being 18 & on SSI) straight Medicaid.

        In an aside, I happened to have very good health insurance when the Emory hospital transplant team saved my life a little over a year ago.

        When I received all the hospital statements, it really pissed me off that due to the discount arrangement between the insurance company & Emory, those that saved my life were paid way less than the independent doctor who created the oops event that they had to fix.  

        Independent Doc Oops got paid at 100% for almost killing me.

         While highly specialized physicians got paid peanuts.

        Strange times.


        •  Children's Hospital of ATL takes all patients (1+ / 0-)
          Recommended by:

          but that doesn't mean that all insurance will pay for Emory/Children's providers.  (This hospital is also known as Children's at Egleston and is located on the Emory campus.)

          I haven't seen the commercials either.  They sound unpleasant.

          btw Lily, Children's Hospital is on the TRICARE provider list.

    •  Funny you should mention ads (1+ / 0-)
      Recommended by:

      I am visiting in Georgia right now, Atlanta to be precise.  On the drive in via I85, I was stunned by the number of billboards to the effect of as you said, "We don't need no stinking government fixing our health care."  Some of those in areas and small towns that were poor and rural.

      There is most certainly a planned effort at manipulation going on here.

      "It's not surveillance, it's data collection to keep you safe"

      by blackhand on Wed Feb 19, 2014 at 02:11:38 AM PST

      [ Parent ]

    •  Emory doesn't care if thousands die (0+ / 0-)

      as long as they get their money.  The GOP is the 1st century Murder Inc.  

  •  The American Experiment (1+ / 0-)
    Recommended by:

    When the Constitution was written, state's right were very important to participants because slavery was such a boon to profits. The constitution was written to accommodate this.

    The fundamental principles underlying the obsolete US Constitution are the very mechanism allow corporations to control people's lives and limit their rights, buy politicians, monopolize media, and own the federal government, itself. Certainly they are free to destroy towns and cities at will.

    This is the life that the colonists in the US are left with -- with their flawed and destructive constitution that does not directly afford a single inalienable human right to the US colonists to this day. And -- they have NO idea they have no rights. Not even the right to vote.

    As an experiment -- which the US is -- and an object lesson to the rest of the world -- the destruction of the health and well-being of the people of Georgia, those who cannot seek refuge in other states, is a very good lesson in natural selection.

    With climate change long past the tipping point, we will see "Staticide" in various regions. States will eliminate themselves, and the Federal government will be left with the role of helping the refugees -- if any -- as they migrate to decent states.


    Not in the least. It is enshrined in the Constitution.

    Sometimes experiments fail.

    •  Slavery was the fatal flaw in the Constitution (4+ / 0-)
      Recommended by:
      Pluto, Mokislab, OldDragon, Dragon5616

      Slavery has poisoned the great American experiment. And genocide of the indigenous people. The sacrifices of the civil war were unable to expiate the original sin of slavery.

      “Industry does everything they can and gets away with it almost all the time, whether it’s the coal industry, not the subject of this hearing, or water or whatever. They will cut corners, and they will get away with it. " Sen. Jay Rockefeller, D, WVa

      by FishOutofWater on Tue Feb 18, 2014 at 04:42:06 PM PST

      [ Parent ]

  •  $7k GA hospital bill here (2+ / 0-)
    Recommended by:
    HeyMikey, Norm in Chicago

    When I lived in GA, my job did not offer health insurance and I could not afford insurance on my own. Then an emergency hit and I had to go to the emergency room of a local hospital.

    Four hours later with a $7000 bill for an IV, a scan (which I told them I did not want nor could I afford), and a 30 second visit with a doctor, I was sent home.

    $85 they charged me for someone to write out, ney, PRINT OUT a prescription for an anti-nausea drug.


    I will never go to Georgia again. Ever. Nathan Deal, Phil Gringey, Paul Broun, Karen Handel, that Graves fireplace nutjob and the rest of the rabidly conservative hacks can go fuck themselves... and so can the people who gleefully vote the previously mentioned into office. I feel no pity.

    Strange but not a stranger.

    by jnww on Tue Feb 18, 2014 at 04:18:55 PM PST

    •  Go to urgent care in a situation like that (2+ / 0-)
      Recommended by:
      Norm in Chicago, Be Skeptical

      Don't use the ER unless you think it's a heart attack.

      “Industry does everything they can and gets away with it almost all the time, whether it’s the coal industry, not the subject of this hearing, or water or whatever. They will cut corners, and they will get away with it. " Sen. Jay Rockefeller, D, WVa

      by FishOutofWater on Tue Feb 18, 2014 at 04:32:39 PM PST

      [ Parent ]

  •  NC hospital CEO I interviewed wants Medicaid (4+ / 0-)

    expansion desperately so that the hospital doesn't get stuck with paying for the uninsured.

    The failure to expand Medicaid will be devastating to community hospitals in North Carolina. Rural citizens and communities will be very hard hit with unnecessary deaths and job losses.

    The Republican bosses are killing their voters.

    “Industry does everything they can and gets away with it almost all the time, whether it’s the coal industry, not the subject of this hearing, or water or whatever. They will cut corners, and they will get away with it. " Sen. Jay Rockefeller, D, WVa

    by FishOutofWater on Tue Feb 18, 2014 at 04:28:53 PM PST

  •  problem is if you want to retire somewhere blue & (2+ / 0-)
    Recommended by:
    HeyMikey, MadMs

    warm you have few options......."stand your ground" Florida doesn't seem to be an option either.....

  •  Just another way Republicans... (5+ / 0-)

    ...are turning the states they run into Third-World sh!tholes.  They can't run a state - they can only run a state into the ground.

    "Life is the crummiest book I ever read - there isn't a hook, just a lot of cheap shots, pictures to shock, and characters an amateur would never dream up." - Bad Religion

    by TheOrchid on Tue Feb 18, 2014 at 05:39:38 PM PST

  •  The latest is abdication of governor's "power" (3+ / 0-)

    re Medicaid expansion through a recent bill co-sponsored by Deal's administration  
    Which basically makes him the first governor in the nation to voluntarily give up his power to alone decide the state of Georgia's future regarding Medicaid expansion.

    Re-election coming up, doncha know.  So he decides the best thing to do for the citizens of his state is to play hot potato with the issue????????  I thought Sonny was bad news well Deal is a real unique piece of work.

    Under House Bill 990, which was introduced Tuesday while much of north Georgia prepared for snow chaos, expanding Medicaid would also require the approval of the state House of Representatives


    Tim Sweeney, director of health-care policy at the Georgia Budget and Policy Institute, a think tank that's urged Deal to consider Medicaid expansion, told us yesterday afternoon that such a move could limit the amount of time Deal or a future governor could expand Medicaid, should he or she want. The General Assembly meets only 40 days out of the year.

    And there's the bigger issue.


    "It's more about the 500,000 Georgians who will be without healthcare if the program isn't expanded... What we're left with is, what is the alternative? If not expansion, what is Georgia gonna do to address the fact that we have one of the largest uninsured populations of any state in the country?"


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