An ambulance races down an empty street in Folkston, Ga., population about 5,000. It bypasses Charlton Memorial Hospital, makes a sharp right turn and speeds to an emergency room 40 miles away.
Why? Because Charlton Memorial Hospital has been closed since last August.
Four of Georgia's 65 rural hospitals have shut down over the past two years. A dozen more have cut services in response to shrinking budgets.
There just wasn't enough money to keep Charlton Memorial going, says Doug Gowen, who stayed and is in charge of what's left of the defunct hospital. A small staff handles the medical records accumulated when it was still in business.
With 25 beds, Charlton Memorial, like many rural hospitals, struggled to cope with a lack of high-tech specialty care, a big drop in local funding and populations that were getting older and poorer.
From his office in a trailer behind the hospital, Gowen can see the locked building that was once the second-largest employer in town.
"Ever since we closed, we've maintained hope that we're going to open back up," he says. "We've not sold any of our equipment. Everything is ready."
The state of Georgia just threw him a lifeline, offering a new kind of license to allow struggling hospitals and those that have closed in the past year to become rural free-standing emergency departments.
"The intent here is to have some kind of health care infrastructure in a community, as opposed to nothing at all," says Clyde Reese, who runs the Georgia Department of Community Health.
He doesn't know of another state that's tried this approach. The new emergency departments would handle run-of-the-mill urgent care, such as broken bones. But they would also stabilize patients for transfer to larger hospitals that are better equipped and staffed.
Reese doesn't know how the free-standing ER would be funded. Medicaid and Medicare could pay for some of the services, but at reduced, non-hospital rates. "This is a first step of not just looking at hospitals but at health care in general in our rural areas," he says.
Because of the strains on the Georgia system, Republican Gov. Nathan Deal created the Rural Hospital Stabilization Committee. One thing that won't be an option: accepting federal money to expand Medicaid to adults without dependent children. That move would cover a half-million poor Georgians. The Republican-controlled Legislature opposes the Affordable Care Act, which created the expansion, and says Medicaid expansion would cost the state too much in the long run.
That's a mistake, says Tim Sweeney, health policy director at the nonprofit Georgia Budget and Policy Institute. "If the primary issue is the financial stability of rural hospitals, then expanding Medicaid should be Step 1," he says.
Georgia is missing out on $31 billion in federal money for the state's health care system over the next decade by not expanding Medicaid, he says. "We know that it would provide significant new funding for hospitals in rural Georgia that are serving uninsured patients right now."
Deal has said he would prefer the federal funding come in a lump sum directly to the state rather than abiding by the federal government's stricter rules for Medicaid.
In Folkston, Gowen fears time is running out for the hospital. He says he will apply for a license to open up the ER, even if he has no idea where the money will come from. "There is a very vital lifesaving service provided in our emergency room," he says. "And if we can get at least that part back up and running, that's vital to this community."
This story is part of a reporting partnership between NPR and Kaiser Health News.
ROBERT SIEGEL, HOST:
In Georgia, four of that state's 65 rural hospitals have closed over the last couple of your years. And a dozen more have cut services to deal with budget troubles. The state now wants to create a new kind of emergency room to help these hospitals stay open. It's called the rural freestanding emergency department. As reporter Susanna Capelouto found out, funding these new ERs will be difficult in a state that has so far decided not to expand Medicaid.
SUSANNA CAPELOUTO, BYLINE: An ambulance is racing down an empty street in Folkston, a town with about 5,000 people in South Georgia. Instead of going another mile up the road to the local hospital, it makes a right turn and heads quickly out of town to an emergency room 40 miles away because the local hospital...
DOUG GOWEN: Has been closed since August of 2013.
CAPELOUTO: Doug Gowen was the man in charge of the defunct Charlton County Memorial Hospital. There just wasn't enough money to keep it going, he says, because the county had budget troubles and pulled its funding. From his office, in a trailer behind the hospital, he can see the locked building that was once the second-largest employer in town.
GOWEN: Ever since we closed, we have maintained the hope that we're going to open it back up because it's very vital to this community. And so we've not sold any of our equipment. Everything is ready to open back up.
CAPELOUTO: The state of Georgia just threw him a lifeline. A new license was created that would allow struggling hospitals and those that have closed in the past 12 months to become so-called rural freestanding emergency departments, says Clyde Reese, who runs the state Department of Community Health.
CLYDE REESE: The intent here is to have some healthcare infrastructure in a community after a hospital closes as opposed to now when they close. There's just nothing at all.
CAPELOUTO: Reese says he doesn't know of another state that's tried this kind of license. These new emergency departments would handle minor cases, but also be able to stabilize patients so they can be transferred to a hospital. Reese doesn't know how these new emergency departments will be funded. Medicaid and Medicare could pay for some of it, but at reduced rates because these are not hospitals. Rural health, Reese says, needs options.
REESE: This is a first step in a long process to look at, not only the issue of hospitals, but also just health care in general in our rural areas.
CAPELOUTO: There are a lot of strains on the rural health system - a declining and aging population and a lot of uninsured. So Gov. Nathan Deal created a committee to study funding for rural health. One thing that will not be an option for the group is accepting federal dollars to expand Medicaid. It would cover half a million poor Georgians. The Republican-controlled legislature opposes Obamacare and says it will cost the state too much in the long run. That's a mistake, says Tim Sweeney, an analyst with the Georgia Budget and Policy Institute.
TIM SWEENEY: If the primary concern, if the primary issue is the financial stability of rural hospitals, then expanding Medicaid should be step one.
CAPELOUTO: Sweeney's group is a nonprofit that crunches numbers in support of health care and education in Georgia. He says for the next 10 years, Georgia is keeping 31 billion federal dollars out of the health care system by not expanding Medicaid.
SWEENEY: We know that it will provide significant new funding for hospitals in rural Georgia, that are serving uninsured patients right now. And after we expand Medicaid, then a comprehensive look needs to be had at how we're delivering services.
CAPELOUTO: Governor Deal would prefer the federal dollars came in a lump sum directly to the state rather than be told by the feds how to spend them. In Folkston, time is running out for the hospital. Doug Gowen says he will apply for a license to open up his emergency room, even if he has no idea where the money will come from.
GOWEN: There's very vital life-saving services performed in our emergency room. And if we can get at least that part back up and running, that's vital to this community.
CAPELOUTO: A community that's caught in the political battle over health care dollars, which promises to be a hot topic this year as Georgia is holding elections for governor and is picking a new U.S. senator. For NPR News, I'm Susanna Capelouto in Atlanta.
SIEGEL: That story is part of a reporting partnership of NPR and Kaiser Health News. Transcript provided by NPR, Copyright NPR.