Gov. Nathan Deal recently said he has no intention of expanding Medicaid insurance eligibility under Obamacare in an effort to save $4 billion over the next decade, but state and local health officials question whether the long-term costs of so many uninsured patients are greater.

Newton Medical Center gave more than $27 million of free care to uninsured patients during the 2011 calendar year, a year in which the hospital operated at a loss, as it did the year before and as it most likely will again this year to the tune of $2.9 million.

Expanded Medicaid insurance wouldn't come close to solving all the hospital's ills, but about 25 percent of Newton's emergency room patients in 2011 had Medicaid, while a similar number were uninsured. The hospital is expecting 13,000 uninsured people to use the ER in 2012, according to Chief Nursing Officer Patty Waller, who oversees patient care.

The hospital loses money on out-patient activities, including the ER, even on people who have Medicaid, but it loses less, and the hospital actually makes money on Medicaid patients on in-patient procedures and activities, Waller said.

Carole Maddux, who runs Good Samaritan Health and Wellness Center in Pickens County for uninsured people, said about 85 to 90 percent of her patients would qualify for Medicaid in 2014 if Georgia were to expand the program.
As important as the bottom line, is the fact that the uninsured epidemic is turning the health system on its head. The ER is meant to be a last line of defense, used for true emergencies, but it's replaced primary care physicians for too many and is threatening some hospitals with bankruptcy.

In addition, people without health insurance, predictably, get more seriously sick more often. They not only eventually cost a lot more to treat because their condition worsens without medical oversight, but they are also frequent repeat visitors because they can't seek medical maintenance, which ultimately comes back and affects the bottom line.

"Emergency room care is some of the worst care - not because there aren't good doctors - because you have sporadic doctors looking at a single issue at a single time," Waller said. "If you have Medicaid, you can go into an office preventive health, with a doctor seeing patients as a patient, not as someone who drops into the emergency room. Then those chronic conditions, such as high blood pressure and diabetes don't get to an ER-level crisis and we've taken care of healthier people at a lower cost.

Waller said some studies have found out that a very small percentage of people make up the major costs of health care, because they get very sick and are not being followed medically through life.

"I'm not saying Gov. Deal was right or wrong, because the cost would go up by hundreds of millions of dollars and we're already in the hole. I understand the concern about cost, but the question has to be asked, which is more expensive. Study after study, shows that with preventive costs you pay up front more, but you save so much (in the long run). The other benefit is citizens are healthier and have a better life."

Another aspect that could hurt hospitals is the fact that, in anticipation of seeing the pool of insured patients rise, the hospitals accept cuts in Medicare payments and in payments from a program that helps cover the cost of providing care to people without insurance. If the Medicaid pool isn't expanded, Georgia hospitals will see their revenues decline even further.

"The decision by the governor yesterday certainly puts us in a spot where we have the cuts but we still don't have the coverage," previously said Kevin Bloye, spokesman for the Georgia Hospital Association.

Bloye said the governor understand that "hospitals are sort of in a conundrum" without the expansion and said the hospitals plan to work with Deal to find a way to keep health care strong statewide.Bloye said the state's hospitals now provide about $1 billion in uncompensated care.

Brian Robinson, Deal's spokesman, said the governor wants to improve health care in Georgia - and he is hoping the November elections might eventually lead to alternatives to the Affordable Care Act.

"We're still hopeful that the American people will demand change in this upcoming election and Congress can deliver change," Robinson said.

In addition, Robinson said previously the governor might agree to expand Medicaid if the federal government gave Georgia a "block grant" of money and the freedom to tailor the program as it saw fit - none of which is currently in the health care law. U.S. Rep. Paul Broun, R-Athens, told The News that block grant program is in his plan, and he wholeheartedly supported Gov. Deal's decision.

"The fix for an unsustainable program is not to make it even more unsustainable," Robinson said.

State Sen. Rick Jeffares, R-Locust Grove, said the state already faces a $300 million shortfall for Medicaid next year alone, and the state simply can't afford additional costs.

He echoed the governor's hope that Congress would ultimately repeal Obamacare.

Rep. Doug Holt, R-Social Circle, and Rep. Pam Dickerson, D-Conyers, declined to comment as they are still studying the issue.

How does Medicaid work?
Medicaid is government health insurance for low-income Americans, mostly children. It is financed jointly by the federal government and the states, with the state's share based on per-capita income. Poorer states pay a smaller portion of their Medicaid spending than wealthier states.

Initially, the Affordable Care Act of 2010 required that states, beginning in 2014, cover anyone in households earning up to 133 percent of the federal poverty level.

But the U.S. Supreme Court ruled in June that expansion must be optional. Republican Govs. Rick Scott of Florida, Bobby Jindal of Louisiana, Phil Bryant of Mississippi, Nikki Haley of South Carolina and Rick Perry of Texas have said they will not expand their programs.

Under the law, the feds would pay between 90 and 100 percent of the cost of the Medicaid expansion, which would add 650,000 Georgians to the program's rolls, which are currently around 1.5 million. But even with the federal government covering so much of the cost, Georgia projects its share of the expansion would reach $4 billion over 10 years.

The Associated Press and reporter Danielle Everson contributed to this story.