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As Hospitals Close, 911 Is Becoming a Joke in Rural Communities


If you work for a hospital in one of Georgia’s rural communities, you should be very afraid. There’s a strong possibility your hospital will be closing down soon because of financial problems. Eight rural hospitals have gone out of business since 2001, four of them in the past two years.

It’s true that hospitals in more populous areas, such as St. Francis in Columbus, are also having financial problems, but the situation is especially acute in thinly populated rural Georgia. The picture only looks darker as time goes on. A special committee appointed by Gov. Nathan Deal last year to examine the situation at rural hospitals released a report warning that 15 of these facilities “are considered financially fragile, with six operating on a day-to-day basis.”

Here’s the problem: Many patients can’t afford health insurance and come to the emergency room to get medical treatment, leaving hospitals with huge unpaid bills. The crushing burden of this charity care makes it difficult to generate the cash flow needed to pay daily expenses.

Hospitals would get some relief if Georgia would expand Medicaid coverage under the provisions of the federal Affordable Care Act. That decision would bring the state more than $3 billion in federal funds each year and provide more than 400,000 uninsured residents with health care coverage. With this expansion, more patients at rural hospitals would have coverage, and hospitals might be able to stay open.

It is rather like using a Band-Aid to treat a cancerous tumor that’s eating away at your vital organs.

Deal, however, does not like the Affordable Care Act, and has refused to accept federal money for Medicaid expansion. He signed a bill last year that shifts the decision on Medicaid expansion to the legislature, whose Republican members dislike the ACA even more than Deal does. The state spurned more than $3 billion in federal funds last year, and will pass up a similar amount this year that would have flowed to rural hospitals desperately struggling to stay alive.  

The special committee that Deal appointed to help rural hospitals didn’t discuss the possibility of Medicaid expansion at any of its meetings and made no mention of the available federal funding in its final report. Instead, the committee recommended the development of a “hub and spoke” network of medical facilities that serve rural areas, with hubs in Blairsville, Baxley, Cordele and Swainsboro. These hospitals would coordinate the treatment with the spokes—smaller hospitals, ambulances with tele-medicine capabilities, school clinics, federally qualified health centers, public health departments and local physicians.

The proposal is not a bad idea, and it may result in more efficient treatment of patients outside urban areas. However, it won’t come close to solving the money problems that are forcing rural hospitals out of business. It is rather like using a Band-Aid to treat a cancerous tumor that’s eating away at your vital organs.

A lot of money would be available to our rural hospitals if state officials would just agree to accept federal funds for Medicaid expansion. It probably wouldn’t save all of them, but it could keep some of them going. By not taking the money, our elected leaders are signing the death warrants for many of these hospitals.