2021 State of State

Lt. Gov. Geoff Duncan speaks ahead of Gov. Brian Kemp during the annual State of the State address on Jan. 14.

ATLANTA — Lately, Lt. Gov. Geoff Duncan has caught eyes as a Republican speaking out against claims of election fraud on national news outlets.

But as a freshman lawmaker and throughout his years in the General Assembly, he was known for his efforts to bolster Georgia’s strained rural health care system.

With the legislative session well underway, Duncan sat down with CNHI to talk about the state of rural health care and the lessons learned during the pandemic.

The lieutenant governor noted his worry that divisive partisan election reform battles may detract from remedying lack of access to care outside of urban city centers —  an issue where Georgia legislators usually find common ground.

"I look at health care as we wasted the better part of 20 years trying to solve the issues around health care nationally, because we've been stuck in partisan corners,” Duncan said. “But the reality is: 11 million Georgians really don't care, when they're sick or hurting or need a, you know, a prescription filled or they need a lower cost on their health care premium. They don't really care who's a Republican or Democrat — they just want somebody to solve their problems.”

Georgia’s rural health care system was arguably already near crisis levels before the pandemic added another challenge.

A number of rural hospitals across the state have shuttered in the last two decades — two more last year due to the financial blow of COVID-19. A steady increase in Georgia’s uninsured population has further complicated reimbursement for services.

Federal coronavirus relief aid that has kept rural facilities afloat often comes with stipulations that limit how the money is spent. Duncan said he hopes future federal aid will come with fewer strings attached but does not believe continued relief will ultimately solve the state’s rural hospital woes.

“I’m certainly grateful for the COVID relief funds that have shown up and allow them to stabilize their ERs and their critical care — especially after their lack of being able to serve the community for a period of time with profitable elective surgeries,” he said. “But we need to focus on trying to make sure that they're able to not just survive but thrive.”

Duncan pointed to his namesake rural health legislation that created a rural hospital tax credit that he said allows more flexibility in spending and has sent millions to the state’s most vulnerable facilities. Industry leaders have praised the measure as a lifeline for rural facilities although it has been criticized in recent years that funds don’t always go to the neediest hospitals.

“There isn't a subsidy big enough to help a hospital if they don't have patients showing up that have the ability to pay for their services,” Duncan said.

The Republican said he is disappointed that Gov. Brian Kemp’s Medicaid waiver proposals were put on hold after the change in presidential administrations.

The waivers would have covered thousands of low-income and uninsured adults if they met a certain work or activity requirement — which President Joe Biden’s administration said was unreasonable during a pandemic. Georgia is one of only 12 states that decided against expanding Medicaid under the Affordable Care Act.

"Fifty-thousand people here in Georgia would have access almost immediately to health care coverage that don't currently have it,” he said of the proposals. "That's a help to those that are maybe not seeking medical attention because they don't have some sort of health package that protects them. Also it hurts the hospital system or the doctor that's providing that health care when somebody walks in the ER, that doesn't have coverage.”

Duncan pointed to the rapid implementation of telemedicine as a success story for Georgia’s rural medical providers during the pandemic. The technology-based medical care reached patients who were miles away from the nearest facility and could instantly bring specialists to areas in need.

“Telehealth as a specific solution, in a matter of weeks, it accelerated years because folks had to use it,” he said.

Still, the success of the technological advancement relies almost entirely on the ability for rural providers and patients to access broadband. Patients who live in areas with poor broadband access, Duncan said, are often the ones who live furthest from medical care.

“Telehealth has expanded the scope, as far as the hospital systems being able to deliver more services — whether it be primary care, specialty, mental health and in remote patient monitoring — you add that together that is a healthy dose of a day-to-day operations of a hospital,” he said. "I hate to see that the only thing that separates (hospitals from patients) is just the digital connection.”

The Republican said there needs to be more coordinated conversations between state and local partners on efforts to increase and expand access to rural health care — from utilizing technology to help solve problems like COVID-19 vaccine distribution to recruiting medical professionals to live and work in rural areas.

“There's entire communities — multiple communities — that count on a hospital that nearly at times is only hours away from making a payroll,” he said. "We can never expect a rural community to grow if they don't even have basic access to health care."

The governor's amended Fiscal Year 2021 and 2022 budget proposals had an increased focus on rural initiatives — including nearly $40 million to establish a Rural Innovation Fund and $30 million to be put toward expanding rural broadband access.

Duncan said he hopes to build on increased funding toward rural areas.

"We're going to continue to look for opportunities to fund through the budget rural health care initiatives and ideas," Duncan said. "And try to really prop up innovation."

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