Never mind Trump Jr. Keep an eye on health care and South Georgia

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Senate Majority Leader Mitch McConnell of Kentucky, joined by Majority Whip John Cornyn of Texas, meets with reporters after a closed-door Republican strategy session on Capitol Hill in Washington. AP Photo/J. Scott Applewhite

You’re forgiven if you think all of America is obsessed with the Trumps and their bewildering matryoshka doll, which always seems to have one more Russian surprise nesting inside.

Cable TV can do that to you.

Just so long as you know that the real news in Washington on Thursday will be the unveiling of a second Senate Republican attempt to do away with the Affordable Care Act and replace it with — well, who knows? Billions of dollars, control of Congress, and perhaps more than a few lives are at stake.

The people undistracted by Russiagate are preparing themselves. Some you can spot by the way they go suddenly silent.

On Tuesday, former Republican congressman Phil Gingrey of Marietta surprised former constituents with an article he had composed and posted on the website of the Washington lobbying firm that now employs him.

Repealing Obamacare made sense in 2010, before it was implemented, wrote Gingrey, a physician. That may no longer be the case. “A solution today should focus on keeping what works, fixing what is broken, and tweaking the areas that need refinement and revision,” he wrote. Rather than “repeal and replace,” we should “retain, repair and revise.”

I was curious about Gingrey’s change of heart. Only three years ago, when running for U.S. Senate, he had pledged to repeal Obamacare or “go home.”

After reading his piece, I picked up the phone and called my former congressman, who was up in D.C. We connected, and made arrangements to talk later in the afternoon. I haven’t heard from him since.

Others prepare for the big event by talking more. Or listening more.

As Gingrey balked on Tuesday, members of the Georgia Professional Lobbyists Association were gathered in Atlanta for a discussion about what might be headed their way. These are the people who live in the state Capitol from January to March every year, following the money. Health care money, especially.

One of their panelists on Tuesday was Charlie Hayslett, a former Atlanta journalist now involved in a writing and research project on the economic and political collapse of rural Georgia.

Hayslett brought out one of his most potent statistics. In 2013, Gwinnett County had 74 percent of South Georgia’s population of 1.1 million. But those 56 counties in South Georgia consumed more than three times as many federal Medicaid dollars as Gwinnett. A total of $927 million.

Around the time Hayslett was moving through his PowerPoint presentation in Atlanta, I had moved on from Gingrey and was working the phone again. This time with Monty Veazey, president of the Georgia Alliance of Community Hospitals.

Veazey may be the most passionate advocate for health care that rural Georgia has. Last month, Veazey hooked up a writer for The New Yorker magazine with Karen Kinsell, the only physician in Clay County, on the Alabama border some 60 miles west of Albany. Kinsell runs the Clay County Medical Center out of a former Tastee-Freez. It was a good piece.

Veazey, who lives in Tifton, was back in Clay County the next week, over the Fourth of July.

“When I left, I had $735 in my pocket. When I got home, I had $35,” Veazey recounted. “I saw patients that the doctor said, ‘You need to go to Phoebe, because you have cancer. And you need treatment.’”

Phoebe Putney Memorial Hospital is in Albany.

“And he says, ‘Doctor, just give me some medicine and let me go back home. I don’t have money to buy gas to get to Phoebe.’ And I said, ‘Well, here’s a hundred dollars. Fill your damn tank up and go.’”

Veazey went on, playing both characters.

“’Well, I don’t own a car.’ I said, here’s another hundred. Go find somebody that does and pay him to drive you,” Veazey said.

Days before Gingrey went silent, before Hayslett brought out his statistics, and before Veazey told his story, a letter had surfaced that was timed to impact the health care debate that resumes today.

It was drafted and signed by the leaders of three influential — and usually silent — Georgia players in the debate over health care: The Georgia Hospital Association, the Georgia Chamber, and the Georgia Academy of Family Physicians.

The letter is an analysis of the impact that the House Republican plan to repeal Obamacare would have on Georgia. And so was offered as a guide to U.S. Sens. Johnny Isakson and David Perdue on what needs to be avoided.

Since the ACA was implemented, the nation has divided itself into states that have expanded Medicaid coverage to a broader segment of their populations, and those that have not. Georgia has not.

The House GOP repeal of Obamacare would make those differences permanent. “By 2025, federal Medicaid spending in expansion states will be $1,936 per state resident compared to only $1,158 in non-expansion states,” the letter states. That’s a 40 percent difference.

Ultimately, the economic development divide that gap would create could be staggering. The link between jobs and access to health care is indisputable. And in human terms, think of the effect such short-changing would have on a rural Georgia that is three times more dependent on Medicaid than suburban Atlanta.

Federal payments made to charity hospitals, intended to be phased out as Medicaid expansion kicked in, also need to be re-imposed, permanently, the letter said.

“Georgia needs additional federal funds to restore payment cuts and cover the costs of uncompensated care,” according to the letter.

It is as a political document that the three-page message is the most remarkable. Never mind Obamacare. Move past “repeal and replace.” Whatever comes next, we just want our fair share. That is the essence of the letter.

At bottom, it’s an argument for the survival of rural Georgia. Which, oddly enough, is Donald Trump’s Georgia.


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