Then along comes the economic downturn. Unemployment goes up; self-paid uninsured soars. We have uninsured in Georgia at about 17%. We have unemployment in some of these rural communities at 15%-18% plus the underemployed. The consequence is that we have a population of hospitals in rural Georgia that are in great jeopardy.
HLM: Do you anticipate more rural hospital closings in Georgia?
Lewis: We have a situation in Georgia where more closings are inevitable.
HLM: Is the rural hospital crisis in Georgia a bellwether for the rest of the nation?
Lewis: That would be correct. Georgia may be at the front end of the pack because of these incremental reductions in Medicaid and because we have so many critical access hospitals. As these rural hospitals close, it dominoes up to the next-larger hospital and the next-larger hospital and as that occurs, it is going to be a big problem. We just move the self-paid and the uninsured up to the next level of hospitals, and we've got a lot of large hospitals whose ERs are bursting already and this is going to compound that problem.
HLM: What will be the effect on rural healthcare access with these closings?
Lewis: I represent 56 hospitals and when I look at the population in those counties, that is about 1 million people. Georgia is a 10-million-person state, so we have about 10% of our population that we can move into Third World Nation health status. They will have to drive 30 to 60 miles to get healthcare.