From the packed hallways of Atlanta’s massive county hospital to the thousands of patients who line up around the state every year to get Obamacare, yawning gaps in Georgia’s overburdened healthcare system aren’t hard to find.
“The need for care is just tremendous,” said Dr. Charles Moore, a Harvard-trained ear, nose and throat specialist who runs an Atlanta clinic for poor patients.
Georgia has some of the worst health outcomes in the country, with high rates of untreated illness and death from preventable diseases.
The state is also home to Dr. Tom Price, the 62-year-old Republican congressman whom President-elect Donald Trump has tapped to be the next Health and Human Services secretary. Trump has charged Price with repealing the Affordable Care Act and developing a replacement that Trump promised will protect millions of Americans who’ve gained coverage through the law.
He is an unorthodox choice for the task.
As a physician in Georgia and a lawmaker for 20 years, first in the state Legislature and then as a member of Georgia’s congressional delegation, Price has relentlessly fought to limit healthcare safety net programs, even as nearly 1 in 5 of his fellow Georgians were locked out of health coverage.
Price’s efforts to cut healthcare programs have stoked opposition to his nomination from congressional Democrats.
His critics are also eyeing his extensive trading in healthcare stocks, including revelations reported by CNN that he bought stock in a medical device maker just days before introducing legislation that would have benefited the company.
The Trump transition team disputes the report, saying the stock purchase was initiated by Price’s broker and the congressman was unaware of it. The issue is expected to feature prominently when Price appears Wednesday before the Senate Health Committee.
Price declined through a spokesman to be interviewed.
Throughout his political career, he has grounded his opposition to safety net programs in his medical experience. Price, whose father and grandfather were doctors, is an orthopedic surgeon who came to Georgia more than 30 years ago from his native Michigan and later opened a solo practice outside Atlanta.
“Healthcare decisions should be made by patients and their doctors, not bureaucrats or insurance companies,” he said in 2007, explaining his votes against expanding the Children’s Health Insurance Program, which now provides coverage to more than 8 million low-income children every year.
According to several of Price’s former medical colleagues, his view reflects a long-standing frustration with limits that insurance programs such as Medicare and Medicaid put on doctors.
“He values physician autonomy and having the patient at the center of care,” said Dr. Steven Walsh, an anesthesiologist who began practicing alongside Price more than 30 years ago at North Fulton Hospital, a quiet, neatly manicured community hospital in Roswell, Ga., where Price still lives.
Many of Price’s former colleagues, including Walsh, recalled Price’s extensive efforts to help doctors by limiting malpractice awards, requiring that they are promptly paid and restricting what medical services can be performed by nurses and others without a medical degree.
Many physicians are frustrated by the growing list of requirements from insurance programs, including that they report patient outcomes, track costs and use approved electronic record systems.
Price’s reaction has been to consistently try to scale back the programs.
While in the state Legislature, he was one of only four senators who opposed the creation in 1998 of PeachCare, Georgia’s version of the Children’s Health Insurance Program, a federal initiative to expand coverage for children from low- and moderate-income families. Price said such children could already get care. At the time, more than 300,000 Georgia children lacked coverage.
Research has shown that CHIP and Medicaid, which also serves poor children, improve children’s access to care, and there are even indications that poor kids who have coverage are healthier as adults.
Price also supported GOP budget blueprints developed by now-House Speaker Paul D. Ryan (R-Wis.) to scale back health protections for seniors by increasing the Medicare eligibility age from 65 to 67 and by shifting more costs to patients by converting Medicare into a voucher system that would give beneficiaries a limited amount of money to shop for private health plans.
And when Price took the helm of the House Budget Committee two years ago, he developed his own budget plans to slash trillions of dollars from federal healthcare programs.
Among the biggest targets was Medicaid, a state and federally funded program that today provides coverage to more than 70 million Americans, including poor children, seniors and the disabled. Medicaid is the largest payer for nursing home care in the country.
Price’s 2017 budget plan, if enacted, would have cut more than $2 trillion in Medicaid spending over the next decade, reducing federal aid to states by close to 40% and probably forcing many to place significant restrictions on who got coverage and which medical services they could get.
Price’s top priority has always been patients, said Dr. William Clark, who has worked closely with Price at the Medical Assn. of Georgia. “He wants patients to be able to have access to their physicians,” Clark said.
But in medical offices, clinics and hospitals that see Georgia’s neediest patients, there are few indications that limiting coverage helps patients’ health.
“The fact is, patients will avoid seeing the doctor if they can’t pay,” said Dr. Evan Weisman, a retired Atlanta cardiologist and longtime advocate for expanding health insurance. “These patients simply never get to your office.”
Indeed, in 2013, 19% of Georgia adults reported skipping needed medical care because of cost. That was the highest rate in the nation, according to state data collected by the Commonwealth Fund, a nonpartisan research foundation that analyzes healthcare systems.
At the same time, the persistent gaps in coverage are putting a growing strain on many hospitals, particularly in rural parts of the state. Half a dozen have closed in recent years, further exacerbating patients’ difficulties getting care.
In Atlanta, Moore, the ear, nose and throat specialist, decided to open his clinic after seeing many uninsured patients with head and neck cancers who only came to Grady Memorial Hospital, the state’s largest safety net hospital, when the cancers were very advanced.
As a result, physicians often could do little for these patients, except relieve suffering. Most died quickly.
“It’s not uncommon for people to have to decide if they can feed their kids or take care of their own health,” said Moore, whose clinic aims to get needed care to patients before their diseases are untreatable.
Georgia has begun to see some improvements since Obamacare’s coverage expansion began. About half a million Georgians have gained health insurance in the last three years, though the state has refused federal aid made available by the law to expand Medicaid coverage.
But the talk of repealing the health law has many Georgians concerned, said Sheila Carter, who helps direct enrollment efforts for InsureGA, a nonprofit that’s been signing people up for coverage.
“People are very, very worried,” Carter said. “They need the insurance.”