It was national news when flammable material stored beneath Interstate 85 ignited an inferno that collapsed a hunk of one of Atlanta’s major traffic arteries on March 30. That very night Georgia Gov. Nathan Deal made a call to Washington and secured a pledge from U.S. Secretary of Transportation Elaine Chao for an immediate infusion of $10 million to deal with the crisis.
Amazingly, the $16.6 million rebuilding job was finished in just six weeks. When it reopened the governor and the secretary held a ceremony beneath the newly poured concrete bridge and congratulated each other for helping ease the pain of Atlanta’s traffic-choked commuters.
When it comes to putting down pavement, Georgia is quick to ask the feds for as much as it can get.
But when it comes to working with Washington to help the poor get access to health care, the story is quite the opposite.
Indeed, that initial $10 million infusion from Washington for the I-85 repair is close to the same amount that Georgia turned back to the federal treasury every single day during 2014, 2015 and 2016. Because Georgia didn’t want to expand Medicaid eligibility the way the Affordable Care Act envisioned, and paid for, it simply walked away from billions of federal dollars.
Yes, you read that right. For three years since the start of the ACA, Republican elected officials in Georgia effectively gave up $9 million a day, nearly $15 billion from 2014 to 2017 alone. Instead, they sent the money back to Washington to be redistributed elsewhere, all in an effort to burnish their Red State, anti-Obamacare cred.
They are still doing it, even though Georgia has a higher percentage of its residents uninsured than all but three other states. To state officials, the very real crisis of securing health care for the poor is not nearly as important as expecting taxpayers in New Jersey, Indiana, California and the other states to pay for repairs for a self-inflicted wound to our interstate highway system.
It’s worth examining the numbers on highways and health care because they reflect the state’s priorities.
For the interstate bridge repair, the feds pledged to pay about 90 percent, or $14.9 million of the cost of rebuilding the burned-out section of I-85, which carries approximately 225,000 vehicles a day through an important quadrant of Atlanta. The state is putting up the rest of what is expected to be a $16.6 million job when all the costs – including a $3.1 million incentive to the contractors for early completion – are tallied. This, despite the fact that the state department of transportation seems at least somewhat responsible for the calamity because it unwisely stored flammable material under the highway.
Now consider what is happening, or more accurately not happening with Medicaid expansion. The feds would have paid 100 percent of the cost of coverage for 300,000 Georgians during the first three years and no less than 90 percent after that. This is where the millions-versus- billons numbers get mind boggling.
Under the law, Georgia was earmarked to receive about $33 billion over 10 years, with much of it coming in the first five years of the law. The money would have gone to secure care mostly for low-income adults who get no insurance on the job and don’t make enough money to afford an individual or family plan on the government exchanges.
The infusion of Medicaid funds would also go a long way toward shoring up the state’s very vulnerable rural hospitals, eight of which have closed since 2012. These small facilities, plus the state’s largest public hospital, Grady Memorial in Atlanta, amount to the safety net beneath the safety net when it comes to health care for the poor.
This preference for federal funding that pays for bricks and mortar and highways over money for health and social services goes back decades in the South, according to historians.
Georgia famously rejected thousands of dollars from FDR’s New Deal programs aimed at providing nurses for public hospitals during the 1930s because it didn’t like the minimum wage rules that came with the grants. But the state lapped up New Deal money that went directly to the state treasury to be used for roads and public buildings. It no doubt helped that state and local officials were in charge of the contracts for those projects.
Similarly, during the 2009 recession, the state’s Republican members of Congress unanimously voted against an economic stimulus package offered by President Obama, proclaiming it would worsen the federal budget deficit. Yet months later they more than willingly had their pictures taken presenting oversized checks from the U.S. Treasury to Georgia municipal officials for new traffic signals, road reconstruction and other projects that resulted from the very stimulus package they voted against. They wouldn’t dare send the money back for those projects.
Public health advocates in Georgia and other southern states are so accustomed to this kind of hypocrisy that it hardly registers anymore. They know, from years of experience, that roads, prisons and economic development schemes always get budgetary priority over programs for the poor.
That’s what makes the current effort by Congressional Republicans to fix funding for Medicaid and turn administration for running the program over to the states so worrisome. Not only would federal funding be substantially reduced -- $880 billion over 10 years in the House-passed bill – the states would get much more control over how it is spent, including who is covered and how much health care providers will be paid.
That’s a prescription for disaster in the South, where states are already notoriously stingy in their reimbursement rates and where other essential health care services partially paid for by the state – most notably care for the uninsured mentally ill, disabled and poor people with HIV – have been plagued by scandal, inefficiency and outright fraud.
Still, it’s good news for commuters that the highway is open again. On this project, the state and feds were great partners.
But there’s this irony to report as well.
The man who has been charged with setting the fire that started the highway conflagration is widely reported to be a homeless, mentally ill, drug abuser. In dozens of states that have a better record of providing services for the poor, Medicaid money is used to care for people just like him. Not so in Georgia, even though Atlanta has a serious problem with chronically ill, homeless people living under highway overpasses.
Perhaps the whole mess could have been prevented had Georgia accepted the money Obamacare offered to help the state get the troubled man the care he clearly needed.
Sometimes, karma can be a bitch.
Mike King is an Atlanta-based journalist and author of “A Spirit of Charity: Restoring the Bond Between America and Its Public Hospitals.” A revised edition of the book is now available in paperback.