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Inside Bulloch Business with DeWayne Grice - Medicaid expansion would help Ga. economy
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DeWayne Grice


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• Matthew K. Hube, former partner in Hube Tucker  is now “The Hube Law Firm, P.C.” and is located at 14 Oak Street.  Robbie Mock, former partner in The Mock Law Firm has joined Hube at The Hube Law Firm.  Hube and Mock are practicing criminal Law, family law, Social Security and real estate law. (912) 764-2400.
• Josh D. Tucker will remain at the former Hube-Tucker location at 209 South Zetterower Avenue and his new firm “Josh D. Tucker, P.C.” will concentrate on personal injury. (912) 764-4878.
• Farmers Market Vendor of the Week: Poor Robin’s Produce

        If you have turned on a TV or opened a newspaper in the past few months, you probably are aware Georgia chose not to expand Medicaid as part of the implementation of the Affordable Care Act.
        There is a lot of political posturing over this issue. But the facts are overwhelmingly supportive of expansion for our community and region when you remove politics from the issue. More importantly, the potential economic impact to our community and region if Medicaid was expanded is remarkable.
        We know that the expansion would enable more than 600,000 low-income Georgians to sign up for Medicaid.
        Also, it would allow rural hospitals to receive payments for services they are required by law to provide to the uninsured. By not expanding Medicaid, Georgia would lose $33.7 billion in federal funding from 2013 to 2022. At the same time, our tax dollars would be spent in states that are expanding Medicaid.
        Four rural Georgia hospitals were closed in the past two years due to financial difficulties. Many others have severe cash flow problems and rural counties have an extreme shortage of primary care physicians.
        In our area, both Evans Memorial Hospital in Claxton and Candler County Hospital in Metter are struggling to survive. Both recently received huge injections of cash from reserves, sales of property and bonds.
In the past, rural hospitals received federal dollars through a disproportionate share (DSH) funding model to offset losses for caring for the indigent and uninsured. However, the Affordable Care Act reduces DSH funding to rural hospitals because it assumes such support would not be needed with the expansion of Medicaid eligibility.
Without disproportionate share support, rural hospitals dramatically reduced services available to patients - or, as in some cases, closed all together.

Medicaid expansion analysis
         According to an analysis of the Medicaid expansion by Georgia State University, in addition to providing healthcare to 600,000 Georgians, the expansion would add more than $8 billion to our economy annually and create 73,000 jobs statewide.
        In our hospital service delivery area as defined by the Georgia Department of Community Affairs, which is composed of a nine-county region, we would see the creation of 4,304 jobs and a $485 million in total output to the local economy. In Bulloch County, we have 15,000 uninsured citizens. Also, we have 15,775 citizens that are food insufficient. That amounts to 22.4 percent of Bulloch's population.
        Topping the list of the top 10 most affected industries financially in Georgia by the lack of Medicaid expansion are private hospitals at number one followed by offices of physicians, dentists and other health practitioners.
        Our primary healthcare provider, East Georgia Regional Medical Center, is a private hospital, which is responsible for 628 jobs in our community. East Georgia has direct expenditures of more than $78 million annually and a total economic impact of $179 million on our area.

Thoughts from East Georgia CEO
        "Because the uninsured population is a significant portion of the state, expansion would allow us to provide additional services to that population that can't afford healthcare but it would also allow rural hospitals to be successful and probably would save some hospitals from closing." said Bob Bigley, CEO of East Georgia.
        "I understand the state's reluctance to expand the program," he said. "It is huge dollars and the impact on the state's budget is going to be significant. However, the economic impact of each individual community by the potential loss of a hospital I think runs the risk of offsetting what the state would have spent. If the hospitals are in a community to support economic growth and they close because they can't afford to take care of the current population of any given community, it then is at risk at losing employers or certainly not being able to attract new employers. I think that is the greater risk other than the financial risk to an individual hospital. These markets could lose the opportunity to grow the economic base."
        Bigley has seen emergency room visits at East Georgia double since he took over as CEO in 2005. If Candler County Hospital or Evans Memorial Hospital, or both, close in their service area closes, he believes East Georgia could absorb everything but the increase in ER visits.
        "Because of the lack of expansion and the instability of smaller hospitals in our area, we are going through the planning stages for a major ER expansion and even looking at intermediate plans to add additional capacity should we need to," Bigley said.
        After the closures of several rural hospitals earlier this year, Gov. Nathan Deal established a Rural Hospital Stabilization Committee. It was created to identify the needs of rural facilities and offer potential solutions. Deal also proposed a regulatory change that would allow rural hospitals to downsize their services, which would allow them to operate an ER only. According to the Georgia Department of Community Health, no hospital has yet applied to do that.
        "There are lots of models throughout the country that prove (operating as an ER only) is not a viable option, because if you are left with one of the highest cost services that has the highest rate of indigent patients, I don't see how a hospital can survive at all. (Operating as only an ER) is not a viable option for most communities," Bigley said.

Arkansas and Kentucky
        For comparison I looked at two other southern states that chose to expand Medicaid - Arkansas and Kentucky.
According to Jeff Bookman with the Atlanta Journal-Constitution:
        Arkansas cut its uninsured rate from 22.5 percent, the second highest in the country, down to 12.4 percent, the 29th highest.
        Kentucky cut its uninsured rate from 20.4 percent, the 10th highest, to 11.9 percent, the 33rd highest.
        Meanwhile, Georgia saw its uninsured rate fall from 21.4 percent to 20.2 percent, a drop of 1.2 percent.
        In addition, Arkansas' number of uninsured people seeking care in their emergency rooms is down 24 percent and the number of uninsured being hospitalized is down 30 percent.
        The stark contrast in the positive healthcare benefits achieved in Arkansas and Kentucky when compared to Georgia make arguing that we are better off not accepting federal dollars to expand Medicaid very difficult to understand.

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