Georgians cannot take healthcare for granted as hospitals in country towns, unable to make ends meet in less affluent, rural areas, threaten to close their doors.
North Georgia Medical Center in Ellijay, Georgia, ceased to exist as a hospital in 2016. Jasper, Georgia is the closest town with a full-service hospital, which poses obvious difficulties for residents in need of immediate care. Yet their dilemma is shared by hundreds of small-town dwellers across the state and the nation.
Georgia has one of the United States’ highest hospital closure rates, according to a Georgia Health News report. But the closures are not unique to Georgia. Rural hospitals across the United States have shut down at accelerating rates since 2010. CNN reports 80 rural hospitals have shut down due to financial strain since 2010, and 673 more hospitals are at risk. Medicaid cuts place the hospitals at greater risk, according to the CNN article.
The Affordable Care Act, championed by the left as as a way to provide coverage to aging, sick people in low-income areas, did little to remedy America’s healthcare crisis. Economist Terree P. Summer explained the redistribution of health care and forcing health facilities to accept lower reimbursements inevitably leads to costs being cut in harmful ways. Because of nationalized health insurance, facilities begin using less expensive medicine and letting doctors and nurses go. In the worst cases, they shut down completely.
The problems with health care funding are exacerbated in poor rural areas. Residents tend to be lower-income, older, less educated about medicine and generally unhealthier than suburban/urban citizens.
Poor nutrition and obesity, for example, are especially prevalent in rural communities. Stigmas against mental illness are more prevalent in rural areas, and rural citizens are more loathe to seek medical attention than more educated urbanites, according to a 2015 Public Health study. Furthermore, simply getting to the hospital is a problem in rural counties where the drive might be 30 minutes or more, according to the study.
Another issue is prenatal care. Rural Georgia has some of the worst prenatal care and maternal mortality rates in the United States, partly due to a shortage of prenatal care clinics, according to a 2016 study from Maternal and Child Health Journal.
Though the ACA did not alleviate the rural health care crisis, the actual problems date back much further than the Obama administration. Though healthcare in rural America never exactly flourished, 1987 saw new records for hospital closings, according to a 1989 Journal of Public Health Policy study. The study attributed high closure rates partly to Medicare’s Prospective Pay System, in which rural hospitals received significantly less funding than their urban counterparts for equivalent services.
The Journal of Public Health Policy study also blames the hospital crisis on insignificant staff. As conventional wisdom states, the brightest and the best tend to leave their hometowns behind pursuing education and work. Doctors and nurses tended to concentrate in urban/suburban areas, leaving rural American hospitals severely understaffed.
The issues have not resolved themselves in the 21st century. Doctors are still in short supply in rural areas because larger towns tend to provide better jobs, according to Public Health. Previously, a loophole in visa requirements allowed foreign doctors to remain in the United States if they remained in understaffed parts of the country. However, the Trump administration threatens to undo this waiver policy with its controversial travel ban.
As Congress debates repealing and replacing the ACA, state legislators have also proposed solutions to the hospital closures close at hand.
Georgia State Rep. Geoff Duncan, (R.-Cumming), for example, proposed tax credits for donors to struggling rural hospitals and creation of 100 more clinics which specifically serve people unable to pay full price for healthcare, according to the Atlanta-Journal Constitution.
However, the problem for public officials is multifaceted: not only must they find a way to sufficiently fund hospitals, they must incentivize medical professionals to stay, and somehow promote better health education and awareness to rural citizens.