By Vineet Raman and Isabela Pavkov
The Atlanta Journal-Constitution, November 14, 2023<
With the closing of Atlanta Medical Center (AMC) a year ago, 6 million people in metro Atlanta have been left with one Level 1 trauma center. It was the first time in recent history the mostly rural phenomenon — hospital closures — hit the state capital. Just like that, another hospital was gone, dealing another blow to the health of low-income Georgians after years of neglect by all branches of Georgia’s state government.
The state government’s response? A onetime infusion of pandemic relief funds into Grady Memorial Hospital to help absorb the influx, which resulted in 182 new beds and a new 16-bed psychiatric unit (AMC had a total 460 licensed beds, with 200 operational toward the end).
Let’s put AMC’s closing in context.
Since 2010, nine rural hospitals have closed in Georgia. These hospitals provided essential services, and their closures leave residents driving hours for life-saving treatment.
They were also keystones in their towns: providing jobs, a tax base for local government and an anchor for businesses like restaurants and grocery stores.
Serving largely uninsured, low-income patients, these hospitals closed because their base of patients were often older, required more expensive care and were uninsured or underinsured, making it difficult for facilities to remain financially viable. Many rural hospitals remain vulnerable, and while federal pandemic relief funds have helped some stay afloat, others have cut back on essential services like emergency rooms, labor and delivery wards and maternity care.
Fast forward to 2016: Tenet Healthcare Corp. sells a group of hospitals, including North Fulton, Spalding Regional Hospital and AMC to Wellstar. In April 2022, Wellstar cut services at AMC South, in East Point, shutting down a hospital and emergency room and leaving the property with only a single outpatient clinic. Four months later, Wellstar announced the closing of AMC.
AMC served a patient population that was about 70% Black and more than 15% uninsured.
However, as evidenced by the closure of two medical centers serving low-income communities and low rankings on equity measures, Wellstar seems to prioritize profit over patients. Wellstar’s flagship hospital, Kennestone, ranks as the least racially inclusive in Georgia and serves only 10% uninsured patients, while AMC ranked in the top 25 in the country for most racially inclusive before it closed. While Wellstar deserted intown Atlanta patients, it expanded Kennestone’s emergency room and strategized a partnership with Augusta University Medical (AUMC). Wellstar, a nonprofit, made $2.1 billion in revenue last year, and spent $91.8 million in expenses to keep AMC running for the fiscal year ending in October 2022.
So how do we solve the issue of uninsured care? We believe it begins with Medicaid expansion, which has been shown to reduce the likelihood of rural hospital closures. For years, Georgia Republicans in the legislature and governor’s office have declined to expand Medicaid. In October 2020, the Department of Community Health (DCH) had a Medicaid demonstration waiver passed (“Pathways”) that would offer Medicaid to certain low-income individuals who meet work requirements. It is the only Medicaid program in the nation with work requirements. However, in reality, this waiver omits coverage for about 430,000 people and costs the state more money. In its first few months, the onerous requirements of registration and work certifications have resulted in fewer than 2,000 enrolled beneficiaries.
Recent headlines also confirmed the post-pandemic redetermination process resulted in 215,000 vulnerable Georgians — mostly women and children — losing access to Medicaid due to bureaucratic reasons.
Other expansion states — including those in the South — have seen much of their population gain regular access to primary care. As physicians and medical students, we refuse to sit by idly and be a part of a system that invests as much time and money into denying and blocking access to care as it does providing care.
Our Nov. 12 rally sought to highlight the injustice committed by Wellstar to the community of South Fulton. Hearing from patients affected by the closure, it’s clear the hospital was key to the health of the community. Entire families saw their lives shaped by the care they received, in their own neighborhood.
The moral injury we deal with on a daily basis pushes us to advocate for a better health care system for our patients, one that is driven by neither profit nor bottom lines. It is clear to us that a publicly funded system of universal and comprehensive health care is necessary to combat the inequities patients face.
A full Medicaid expansion is a first step in improving Georgians’ access to care and keeping existing hospitals up and running.
While we advocate for this compromise, we haven’t lost sight of our goal of universal health care.
Vineet Raman and Isabela Pavkov are members of Students for a National Health Program, a group of allied health profession students pushing for a single-payer health care system in the U.S. Both grew up in Georgia and earned undergraduate degrees here. Raman is a third-year medical student at the University of Minnesota. Pavkov is a third-year medical student at the Medical College of Georgia.