“The poor health status of Southerners is a great disappointment to me as I have spent most of my career trying to improve the health of our citizens. Especially disappointing is our Southern legislative leaders and Governors rejecting a major federal program which would have assisted many of our working poor and saved many of our rural hospitals.”
~ Douglas Skelton, M.D.

When one looks at a map, one discovers that almost the entire southern part of the USA, including the entire deep South, has not expanded Medicaid. Therefore, the rates of uninsured are much greater there versus the nation as a whole.
When compared to the rest of the USA, the South is also not very healthy. We state this fact based on specific national health data collected and analyzed by the University of Wisconsin for the Robert Wood Johnson Foundation project entitled “County Health Rankings and Roadmaps”.
For example, premature deaths before the age of 75 for the USA as a whole are 6,700/100,000 residents. Using our home state of Georgia as an example for this column (only Texas and Florida have a higher percentage of uninsured), the figure is 7,500. In fact, the worst rated Georgia county is 16,200/100,000, nearly triple the national average.
It is not just the rural areas. Bibb County (Macon), the home county of one of the authors, is even worse than the rest of the state, ranking 143 out of 159 counties on statistical health outcomes and 98 on general health factors.  Premature deaths are 11,000/100,000 versus 7,500/100,000 for the state. Low birth weight rate is 13 percent versus 10 percent for Georgia (and 6 percent for top performing USA counties).
Other stats show a similar trend, including those using perceptions of health by our citizens. Georgians self-reported poor/fair health at a much higher rate than Americans in general, 19 percent to 16. Obviously, a major reason for this situation is that Georgia has a rate of medically uninsured (under 65) that is much higher than the national average, 16 percent vs. 11.  This dismal situation was caused by the failure of our state to enact Medicaid expansion via the ACA (Obamacare), although 90 percent of the cost of expansion is paid by the federal government.
The bottom line is that Georgia remains a less healthy state versus the nation. In Southern “red” states, this politically motivated scenario plays out in state after state. Clearly, providing health insurance to more citizens would have a great positive impact on these states.
Many on the right say that Medicaid expansion is insurance for those who choose not to work, and that is why they do not support expansion. That is incorrect. The vast majority of those who would be covered are the working poor, often our friends, neighbors, and relatives.
Further, the respected group Georgians for a Healthy Future states that Medicaid Expansion would create 50,000 new jobs in Georgia alone, mostly in the private sector. The same job creation scenario is true in every other state in the South.
Hospitals in non-expansion states which serve a disproportionate number of medically uninsured would also cut their bad debt via Medicaid expansion, removing one of the key factors causing medical price increases. Also, many public hospitals in these states are asking for increased public subsidies paid for from local taxes. These outlays can be dramatically reduced with lower hospital bad debt.
Healthcare was a major factor in the Democrats winning the House in the Mid-Terms. The GOP leaders of Georgia and other Southern states should endorse Medicaid expansion in 2019, if for no reason other than politics.
Before the 2020 elections, candidates for Southern state-level elected offices should be compelled by voters to state their position on Medicaid expansion. If opposed, each must be asked to explain why he/her continue to reject a program which will benefit so many of our citizens and the health care professionals and hospitals that serve them.


Jack Bernard is the former Director of Health Planning for Georgia. He retired as a SVP with a national healthcare corporation and is a nationally published expert on health reform.
Dr. Doug Skelton is currently the Chancellor of Trinity Medical School of Sciences and was a Georgia district health officer and Dean of Mercer Medical School.