By Tom Baxter

A test of wills involving some of the state’s most powerful figures briefly threatened to derail this year’s General Assembly session last week. It was a brief storm, but it made a stark contrast with what our neighbors in North Carolina were doing.

In an op-ed published in the Atlanta Journal-Constitution Saturday, Lt. Gov. Burt Jones threw in the towel on Senate Bill 99, that would have changed the rules for hospital permitting and according to some critics would have advantaged Jones’ father, who owns property at a possible hospital location in Jackson County.

SB 99 was strongly opposed by Wellstar Health System, which owns a Butts County facility which would be in competition with the facility for which Jones sought permission. Wellstar also wants to take over the Augusta University hospital system, and that in turn drew University System of Georgia Chancellor Sonny Perdue into the broadening conflict.

With SB 99 stalled in the House, Senate budgeteers yanked from the higher education budget a total of $105 million, the same amount Gov. Brian Kemp put in the amended 2023 budget to buy Augusta University an electronic records system as a sweetener for the Wellstar takeover. These cuts, Perdue warned, would negatively impact the entire university system.

That threat appeared to be enough to get Jones to back down, at least for this year. In his op-ed, he took a couple of parting shots at Wellstar, alluding to its closing of the Atlanta Medical Center, which he said “brought metro hospitals to a breaking point and threatened the state.” He also claimed lobbyists, presumably for Wellstar, had offered him a deal in which an exception would be made only for the property in Jackson County. He spurned the deal, he wrote, because his aim is “expanding access for all of rural Georgia.”

This underscores one of the great ironies of the healthcare story. Rural hospitals are struggling and large areas of the state are becoming healthcare deserts. Yet the intense conflicts which inevitably erupt over certificates of need and the high-powered lobbying around any effort to tinker with the rules make it clear that rural healthcare is not only raw need but big business.

Like Jones in Georgia, conservative Republicans in North Carolina have also pushed against their state’s certificate-of-need law, charging that it inhibits hospital construction in rural areas. A compromise on this issue was, in fact, one of the last pieces to fall in place before the North Carolina House gave final passage last week to legislation accepting the federal Medicaid expansion.

Under the legislation, the expansion can’t begin until the state budget is approved this summer, which could lead to some high-stakes negotiations between Republican legislators and Democratic Gov. Roy Cooper, who signed the bill Monday. But the measure passed by such sweeping majorities — 87-24 in the House and 44-2 in the Senate — that the expansion seems certain to go forward.

The passage represents a sweeping bipartisan achievement in a state where there have been bitter partisan divisions in recent years. Cooper has worked for years with hospital groups and other advocates for the expansion, but a crucial role was also played by Republican legislators who adamantly opposed the expansion a decade ago and gradually changed their minds because of what they heard from voters in their districts.

“If there’s a person in the state of North Carolina that has spoken out against Medicaid expansion more than I have, I’d like to meet that person,” state Sen. Phil Berger said last year, announcing that he’d changed his mind. The working poor of his state needed relief he said, and the measure posed no risk to the state budget. By the time the issue came up this year, most Republican legislators had already reached a general agreement over the need for the expansion, with side issues like certificates of need as the final obstacles to passage.

With the vote in North Carolina last week, only 10 states, including Georgia, have not accepted the offer extended under the Affordable Care Act. Until that changes. our big healthcare stories will continue to be about powerful interests competing for their share of a market based on human needs, and not about any progress in addressing those needs.

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Tom Baxter

Tom Baxter has written about politics and the South for more than four decades. He was national editor and chief political correspondent at the Atlanta Journal-Constitution, and later edited The Southern...

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  1. Let’s not bury it. Georgia’s refusal to accept the Medicaid expansion has decimated the state economy, especially below I-20. Yet the proponents of expansion have been unable to gain any political traction there.

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