Three rural hospitals have shut down this year in the state, and as many as 15 more may be closing their doors in the coming months. That’s according to Hometown Health, a trade association representing 56 rural hospitals in Georgia. The hospitals have been fiscally stressed for years, due to the large number of indigent patients they treat. Many have been operating in the red.

As part of the Affordable Care Act, hospitals across Georgia will be losing about $400 million in federal subsidies to pay for care for indigent patients over the next four years. Those subsidies are called disproportionate share hospital payments.

The expansion of Medicaid was approved to help bear some of that cost. But it was left up to the states to decide whether or not to expand. The first three years the federal government will pay 100 percent of the costs. After that, the federal government will pay 90 percent. Georgia has decided not to expand the Medicaid program.

Brian Robinson, a spokesman for the Governor said "These problems are just the latest incarnation of "how Obamacare doesn't work." And he told GPB last month the state cannot afford to commit to expanding Medicaid because the costs will be too high.

“If we expand Medicaid, we’re on the hook for that 10 percent and most people believe, if they really look at it, that that 10 percent isn’t going to stay 10 percent forever; that as the federal government looks for ways to pay off its $17 trillion debt, it’s going to start cutting corners on the biggest expenses and Medicaid is going to be one of the biggest expenses,” explained Robinson.

“So, it’s going to be a prime target for future budget cutters on the federal level and we have to plan for that. It would be irresponsible to commit future Georgian’s paychecks to a program that we already know is unaffordable.”

He said "These problems are just the latest incarnation of "how Obamacare doesn't work."

Jimmy Lewis, CEO of Hometown Health, says the hospital closures will hurt everyone.

“We lose economic development engines. We lose quality of care and access to patients in rural Georgia. And it becomes a tremendous event,” said Lewis. “We certainly can see the evolution and creation of a third world nation in our rural parts of Georgia simply by having destroyed the access to healthcare that we know is so vitally important to that population.”

Lewis says after the hospital in Folkston, Georgia closed, a woman burned in a bonfire had to be taken to the Shands Jacksonville Medical Center in Florida for treatment.

“And she was burned dramatically and did not have access to healthcare. In over a period of an hour and a half or so she was without morphine and without pain drugs to help her. And she then had to be transported to Shands,” said Lewis.

Lewis points out rural hospitals serve a million people in Georgia, and that doesn’t count all the people who travel through rural parts of the state who may need emergency care.

The future is looking bleak for some at risk facilities. Lewis says rural hospitals have been under stress for years, and local counties aren’t in a financial position to pick up the slack. He says as hospitals close, it puts more pressure on facilities that remain open.

Even larger hospitals are feeling the pressure. Atlanta Mayor Kasim Reed says Grady Hospital, the largest public hospital in the state, is at risk of losing $100 million in annual payments for indigent care.

Maggie Gill, President and CEO of Memorial Health University Medical Center in Savannah, says they could lose $17 million over the next four years. She warns that loss could force the hospital to have to cut back on services. But she would not specify where those cuts might come from.

Gill says Medicaid targets those who can’t afford health insurance, so the new health exchanges won’t relieve any of the pressure hospitals face regarding indigent care. She says expanding Medicaid in Georgia won’t relieve the entire burden of the lost payments, but it would help.

Tags: Medicaid, hospitals, obamacare, indigent care