Around 4am last Christmas Eve, Kuanita Murphy’s father suddenly became short of breath and briefly passed out. Without a medical facility nearby, Murphy had to drive him 45 miles east to Albany, Georgia, to the Phoebe Putney memorial hospital. The only hospital in their small town of Cuthbert, Georgia – Southwest Georgia regional medical center – had closed down three years earlier due to financial strain from failing infrastructure and an increase in uninsured patients.
After waiting for several hours, Murphy’s dad was finally admitted at noon into a hospital room for internal bleeding and a restricted heart valve. While he eventually underwent lifesaving surgery, Murphy said that he would have received treatment faster had Cuthbert still had a hospital.
“He had some pain dealing with his chest and the anxiety of not knowing exactly what was going on with him,” Murphy, the editor of Rural Leader magazine, said. “That made it worse off than it probably was, not knowing and having to wait.”
Hospital closures are top of mind for Black voters throughout Georgia, since it’s one of 10 states to reject Medicaid expansion. On Wednesday, Kamala Harris launched a two-day bus tour through south Georgia that will culminate with a rally in Savannah on Thursday afternoon. “Campaigning in this part of the Peach state is critical as it represents a diverse coalition of voters, including rural, suburban and urban Georgians – with a large proportion of Black voters and working-class families,” the campaign said in a statement.
Since 2013, 12 hospitals have closed down in rural and urban areas throughout the state, according to the Georgia Hospital Association. In 2022, two Wellstar Atlanta medical centers closed in the Atlanta metro area, where more than two-thirds of the 4,281 emergency room patients were Black, according to 2019 data from the private, non-profit Wellstar Health System cited by the Atlanta Journal-Constitution.
In Murphy’s eyes, the shuttered medical facility where she was born 49 years ago has served as a rallying cry before the upcoming presidential election. The city’s residents, she said, want to “back a candidate that is going to support Medicaid expansion, or affordable access to healthcare”.
Murphy, like most residents in majority-Black Cuthbert, has long voted Democrat. Although Joe Biden won Georgia in 2020, the first Democratic presidential candidate to do so since 1992, the Republican-led state legislature has rejected expanding Medicaid coverage to more lower-income adults. The Biden-Harris administration has long urged all states to expand Medicaid – a legacy that health policy experts predict Democratic nominee Harris will continue if she becomes president.
Throughout her vice-presidency, Harris has discussed the need to expand Medicaid coverage for postpartum mothers from two to 12 months after giving birth. “We also must work together to call on Congress to advance other components of our Build Back agenda, to expand Medicaid in every state,” Harris said during a speech in 2021. “People live in every state, that’s the logic.”
Floundering healthcare facilities might stay open if they have received Medicaid reimbursements for patients who otherwise couldn’t pay their bills, according to health policy experts. As they gear up for state and federal elections, healthcare advocates and community organizations say they want Georgians to vote for candidates who prioritize affordable and equitable access to healthcare.
Bobby Jenkins, the Cuthbert mayor, believes that the state’s hospital closures could drive voter turnout there. “That’s a way of engaging people in the electoral process to get them to understand this is a direct impact of your vote, or it could be a consequence of your lack of voting,” he said. Case in point, Jenkins said, is that Biden-Harris’s 2025 fiscal year budget includes “Medicaid-like” coverage to people in states that haven’t expanded the program. Meanwhile, Donald Trump sought to repeal Medicaid expansion and supported work requirements for people to qualify for free government healthcare during his presidency.
‘Our governor said no, which is crazy’
According to surveys and canvassing sessions, access to healthcare has remained the most pressing concern only behind the economy for Black and brown communities over the past two years, said Kierra Stanford, the lead community health organizer for the non-profit New Georgia Project. At ice cream teach-ins and public meetings, Stanford tells residents that hospitals could stay open if state and federal leaders expanded Medicaid. While the group is nonpartisan, they encourage voters to research candidates’ stances on healthcare.
Healthcare redlining, which Stanford defined as “the deliberate managing of healthcare resources in Black communities”, has led hospital systems to divest from historically marginalized areas. “It’s an ongoing trend,” Stanford said, that “has been exacerbated by not expanding Medicaid”.
In May, Stanford held a public meeting with 30 attendees in East Point, Georgia, a majority-Black city south-west of Atlanta, to discuss the connection between hospital closures and the state’s refusal to expand Medicaid. A few days later, the New Georgia Project packed the public comment period of an East Point city council meeting to share their concerns about access to healthcare.
On the state level, the New Georgia Project releases a voting guide to alert voters of pressing healthcare concerns before elections. Eventually, they plan to roll out a scorecard that shows the state politicians who didn’t vote to expand Medicaid. On the national level, Stanford explains to voters: “Georgia has literally been offered the funds, but our governor said no, which is crazy.”
“I try to tell people that the money that’s being taken out of your check for federal taxes,” Stanford said, “you’re paying for healthcare for people in California, for people in these other states that have expanded Medicaid.”
Hospital closures hit Black rural communities the hardest, said Sherrell Byrd, executive director of Sowega Rising, a Georgia-based non-profit focused on coalition-building and rural revitalization. “When a hospital closes in rural areas, it’s much more devastating than in urban areas, because it’s like a black hole,” Byrd said. “It takes out a whole subset of the economy side of the community.”
It’s common for residents to drive up to an hour or to cross state lines to access hospitals. The organization encourages rural residents to speak to their legislators about their healthcare access concerns, but Byrd said that politicians have not shared any steps they have taken to solve the issue.
“That’s where people start to be frustrated, because year after year, they still don’t have hospitals,” Byrd said. “And so that’s when people become disenfranchised.”
Hospital closures are top of mind for Medlyne Zamor, a Rockdale county voter who was previously unconcerned about candidates’ healthcare platforms. She didn’t see the need to expand Medicaid and thought that the state would benefit from funding other institutions. However, after a spate of hospital visits due to fibroids in 2022, Zamor met other patients who had been personally affected by the closures. Some of them had needed to wait several months to see specialists. That opened her eyes to the issue, she said: “When I saw how the hospital closures … impacted them in the community, it definitely made me shift my vote to expansion.” Now she only votes for candidates in state and federal offices who support Medicaid expansion.
As a result, Zamor began volunteering at the New Georgia Project, where she hosts events to inform Georgians about the lack of access to healthcare. She also addresses the issue by phone banking, sending out email blasts to residents and writing senators. “These hospital closures, not only does it affect the nearby citizens,” Zamor said, “but also it affects the workers, and it affects the [remaining] hospitals, too.”
State and federal politicians hold the power in slowing down the closures by extending healthcare coverage to lower-income adults, “relieving fragile hospitals from providing free care to uninsured patients”, said Laura Colbert, the executive director of the non-profit Georgians for a Healthy Future. “After that, state and federal leaders should work together to slow consolidation among hospitals and other investors, which can accelerate some rural hospital closures.”
Congress members have stepped up to save Cuthbert’s healthcare system after its only hospital closed four years ago. The city plans to establish a new hospital after recently receiving nearly $12m in federal funding. The Randolph County Hospital Authority is currently working with an accounting firm on a feasibility study to ensure that the facility stays in the community for good.
