ATLANTA -- Georgia's annual legislative session began in January with a spotlight on rural Georgia, as some of the state's top politicians lamented the financial stresses that are shutting Georgia's rural hospitals.
But as the session starts to wind down, there is still plenty of debate about what to do with rural health and other problems in less-populated communities.
Rural hospitals and health care are the top concerns and priorities for the state Legislature's Rural Caucus, said its chairman, state Rep. Jason Shaw, R-Lakeland.
"It's no secret that our rural hospitals are struggling, and also some of the larger regional hospitals are struggling," Shaw said.
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Several rural hospitals have closed in Georgia over the past few years, killing good jobs and shuttering places that are important to nearby residents and businesses. Besides that, a handful of rural counties lack a general practitioner, and even more lack specialist doctors such as OB/GYNs.
Part of what puts rural hospitals in poor financial health is their relatively high caseload of patients who have no insurance and can't pay their bills.
There are some ideas in the works to deliver better health care to rural places, which generally includes counties with fewer than 35,000 people. Last week, the state House passed a bill to let people and companies make tax-deductible donations to nonprofit rural hospitals. Its sponsor, state Rep. Geoff Duncan, R-Cumming, said House Bill 919 would be a way to "laser focus" tax dollars on financially stressed rural hospitals. His Democrat critics said it would be better for Georgia to expand Medicaid, the government insurance program for low-income people.
Some lawmakers are looking to deal rural health onto the casino gambling table. Last week, a state House panel approved the idea of asking Georgians to approve casino gambling, on the grounds that it would help pay for lottery-funded HOPE scholarships and pre-K classes. But more than one lawmaker, including state Rep. Rusty Kidd, I-Milledgeville, has spoken in favor of directing casino money to rural health.
But given that the point of lawmakers taking up casinos is to shore up HOPE and pre-K, using some of the money for rural needs might be a hard sell. It's not the first time lawmakers have tried to come up with a dedicated source of money for rural health, though. In a 2010 referendum, voters turned down legislators' idea of paying $10 extra for license plates to bankroll rural emergency rooms. The idea of casino cash may go to the same place: nowhere.
But the state budget is fattening up a little as Georgia comes out of a recession. And there is some spending planned, including start-up funds for clinics in Jackson and Jenkins counties. And besides that, Gov. Nathan Deal is splitting $70 million from a settlement with the federal government between Mercer University and the Morehouse School of Medicine. Both schools train doctors who will work in the state's underserved areas.
But the Legislature has yet to take up some of the ideas that came out of the Rural Hospital Stabilization Committee, a study committee created two years ago. The committee recommended letting practitioners like physician assistants and nurse practitioners perform some of the primary care jobs that are now reserved for doctors.
"In Georgia, that's a tough issue ... we've had a hard time getting those bills even heard," Shaw said.
ISSUES REACH BEYOND HEALTH
But stresses in rural communities go beyond health.
"They're not in many ways all that different from stressors in an urban environment," said Bobbie Robinson. She's dean of the School of Liberal Arts at Abraham Baldwin Agricultural College in Tifton and one of the people who helped create its Rural Studies program.
The stressors just look different. Take "food deserts," for example, she said. Food deserts, as defined by the federal government, are areas where a significant share of people are poor and live far from places to buy fresh groceries. In cities, the distances are measured in a mile or two. In the country, it could a dozen miles or more between a person who does not have a car and a grocery store.
Things such as transportation, workforce development and education are challenges in rural areas as well as urban ones, she said.
Under all those stresses, "a lot of these little towns are just drying up on the vine," Robinson said.
Shaw said that part of the Rural Caucus' job is always to make sure rural counties get the resources they need. He and others are optimistic on a few policies.
New transportation funding from a change in gas taxes last year will be helpful for rural roads and bridges, Shaw said. And the state does put money into getting broadband Internet into schools.
Several lawmakers mentioned being interested in watching a broadband project in southwest Georgia. There, seven counties banded together to create a technology authority and are starting to offer fast Internet in some places where utility companies don't go.
Shaw said he would like to look into creating what he's tentatively calling a "rural institute," somewhere, perhaps at a college.
"I do think it would help to have some professionals that can really start homing in on what is needed in these rural communities and how to get there," he said.
"That could not only support us rural legislators up here, but it could also be some support for these rural communities. So, we're still talking about that."