COMPASSIONATE CONSERVATISM IN GEORGIA

“Hate the government” politicians have saturated the media with rhetoric maligning the tremendously beneficial Affordable Care Act (ACA). On a re-run of last nights, Rachel Maddow’s Show (MSNBC), she did a beautiful job of explaining just one of many complex health care problems that is completely solved by the ACA. It was refreshing to hear this against that background of hate.

Using a poverty stricken rural area in Georgia coupled with the attitude of the governor and legislature of that state, Nathan Deal, she explained that eight hospitals closed their doors. This was the result of a federal law. In 1986, President Ronald Reagan signed the Emergency Medical Treatment and Active labor Act (EMTALA) into law legislation. That law mandated hospitals to accept all emergency patients presented for treatment regardless of their ability to pay and then stabilize them before they can lawfully discharge or transfer them to another facility. The hospitals that accept government money from Centers for Medicare and Medicaid (CMS), a branch of the Department of Health and Human Services (HHS) are subject to a hefty fine per violation if they do not comply. A hospital in a rich area or even in a middle class area over charge paying costumer to help support this mandated service; hence, survive as a profit making organization. In a poor area, where many people do not have health insurance, obviously the number of paying customer is smaller and the emergency room load is higher creating an insurmountable economic imbalance.

The Medicaid Expansion included in the ACA is where the money comes from to support hospitals for accepting patients that cannot pay. According to a Supreme Court ruling, the governor an state leaders can accept or reject the Medicaid Expansion. Georgia State Governor Nathan Deal joined 13 other Republican governors in rejecting the ACA expansion; “No, I do not have any intentions of expanding Medicaid,” he said in an interview and added, “I think that is something our state cannot afford.” It is worth noting that the Federal government picks up 100% of the cost for three years followed by picking up 90% of the cost thereafter.     

What is clear is that Governor Deal has no reason for denying people health care; he is acting in a mean spirited way. As Maddow so clearly pointed out, the people who suffer are not only the poor but also everyone who lives in that area. I have pointed out several times in various blog posts, young healthy young people do not want to pay for health insurance. In addition, the Reagan EMTALA law is an additional disincentive for them not to buy insurance, if they have a medical emergency; they go to the emergency ward and are treated; free of charge. Under these circumstances, what attitude does a reasonable person expect a state governor to have toward mandated emergency room treatment? Guess what? Governor Nathan Deal has moved to repeal Reagan’s law.  Let me recapitulate this incredible story: a Republican governor, by rejecting ACA Medicaid expansion, has pursued a policy that lead to closing of hospital in the poorest areas of his state which denies emergency medical care to all people in those area then moves politically to deny uninsured people across the entire state access to emergency room care.

I think of an invincible “tough young healthy dude” dressed in camouflage carrying a pistol on his hip, which he can do because of the second amendment, and riding a motorcycle without a helmet, because he can. He hits loose gravel, skids, and falls and slams his head into a curb. He is carried to a hospital that does not accept government assistance; therefore, does not have to comply with EMTALA. They refuse to treat him because they can— Governor Deal lost a supporter—fair is fair!    

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