Like many neighborhoods in cities across the country, Atlanta's Old Fourth Ward is changing.
Condo buildings and modern minimalist homes punctuate city blocks of low-income housing. Many longtime residents of the historic neighborhood where Martin Luther King Jr. was born have been priced out and pushed to other parts of town.
Atlanta Medical Center, a 460-bed Level 1 trauma center, will be the next fixture to change.
Despite banners proclaiming the hospital’s commitment to the area — "120 Years Caring For Atlanta," one reads — its nonprofit owner, Wellstar Health System, recently announced plans to close the hospital’s doors on Nov. 1.
Georgia has seen several rural hospitals shutter in the past decade, but this year Atlanta has joined other urban centers with facility closures, including a previous downsizing at a facility in the nearby city of East Point.
The Wellstar announcement has stoked the political debate over Medicaid expansion ahead of the Nov. 8 midterm elections. Like 11 other states, Georgia has not expanded eligibility rules for its Medicaid program under the Affordable Care Act, and hospital officials across the state say inaction has hurt their bottom lines because they still treat high numbers of uninsured patients, many of whom cannot pay for treatment.
The Wellstar announcement shocked city officials, including the mayor, Andre Dickens, as well as other members of the community.
On a recent weekday morning, Teresa Smith, 60, who lives in the neighborhood, said she frequently receives care there for a chronic digestive issue. "This hospital will be missed by the whole community," she said.
Liliana Bakhtiari, the Atlanta City Council member whose district includes the hospital, was sharp in her assessment. "There will be loss of life and critical injuries that will not be taken care of, and I wish that mattered more to Wellstar," she said.
Wellstar declined KHN's request for an interview about the closure.
Nancy Kane, an adjunct professor at Harvard's T.H. Chan School of Public Health, sees connections between the Atlanta situation and hospital closures in other major cities.
Many were acquired by large health care companies as part of package deals, and served largely low-income, minority populations.
"If you acquire a hospital, you should have an obligation to fix it up," said Kane. "Wellstar has the funds to invest in this hospital. It's a choice."
Some community members wonder whether the hospital closure will lead to a pricey real estate development on the roughly 20 acres Wellstar owns in the neighborhood.
Randy Pimsler, an architect whose firm has designed projects in the area, said "it could become a blank slate, either for redevelopment or for new development."
Politicians have been quick to turn the closing into a campaign issue. And at the center of the debate is Gov. Brian Kemp's health care policy.
The Kemp team is working to put together a long-term plan for strengthening health care in the area after the closure, said Andrew Isenhour, a Kemp spokesperson. Kemp, a Republican who's running for a second term in November, is unlikely to try to keep the facility open.
But officials at the nonprofit Grady Health System said this week that they have met with Kemp's office, Dickens, and officials from Fulton and DeKalb counties about a financial infusion of state funding that would support capital needs at Grady Memorial Hospital, a Level 1 trauma center about a mile from Atlanta Medical Center.
Grady is expecting as many as 2,500 extra emergency room visits a month after Atlanta Medical Center shuts its doors.
"We can absorb all the trauma," said John Haupert, CEO of Grady Health System. Still, the added ER crunch will be a challenge with more patients arriving, said Ryan Loke, chief health policy officer for Grady.
State funding would accelerate Grady's existing plans to convert offices into inpatient care spaces, which would add more than 180 adult beds as soon as a year from now. The hospital also is adding 40 to 45 beds over the next six weeks, and is planning to install a 24-bed field hospital to help handle the patient flow from the closed hospital.
The closing puts Medicaid expansion "front and center" in the political conversation, Haupert said. Kemp has proposed a limited plan that would offer access to the state-federal insurance program to people who can fulfill a work requirement or similar obligation.
His challenger, Democrat Stacey Abrams, has long made expanding Medicaid a top campaign issue.
"This is no longer a surprise," Abrams said. "It is expected to happen because the Kemp administration refuses to take action."
U.S. Sen. Raphael Warnock (D-Ga.), pastor of Ebenezer Baptist Church, which is less than a mile from the hospital, has also decried the closure and cited the strain on health care facilities caused by Georgia's refusal to expand Medicaid. Wellstar officials have said that Medicaid expansion alone wouldn't have kept the Atlanta facility open.
Earlier this year, Wellstar stopped providing emergency room and inpatient services at its hospital in East Point, just southwest of Atlanta. At the time, it said those patients could be seen at Atlanta Medical Center, about 8 miles away. Haupert estimated it would cost hundreds of millions of dollars to modernize the soon-to-close Atlanta hospital, which is what made a rescue difficult.
The closures just a few months apart could help Abrams' arguments for Medicaid expansion resonate with voters, said Andra Gillespie, an associate professor of political science at Emory University. "An issue that was probably tailored more towards rural Georgia now all of a sudden becomes an Atlanta-area issue," she said.
Gillespie cautioned that other issues, such as inflation, crime, and abortion, are likely to be more motivating to Georgia voters.
Wellstar, based in suburban Marietta, acquired AMC and the East Point hospital from Tenet Healthcare during an acquisition push in 2016, part of a $575 million deal that included three other hospitals in the metro region.
Todd Greene, formerly a member of Wellstar's community board for AMC, said the system put more resources into its suburban facilities.
"Wellstar's suburban hospital-oriented management approach unfortunately has resulted in large portions of Atlanta's black and brown communities not having access to proximate and critical health care services," he said in a written statement.
In Wellstar's announcement of the closure, it said it had invested more than $350 million in capital improvements at the facility since 2016 and sustained "$107 million in losses in just the last 12 months, amid decreasing revenue and increasing costs for staff and supplies due to soaring inflation."
The decision to close the hospital didn't come as a surprise to some staff members, said Dr. Sulieman Wazeerud-Din, an emergency medicine physician at the hospital, who said doctors "were aware of financial losses."
But the abrupt announcement caused a profound sense of grief among doctors, nurses, and other nonmedical employees, he said.
In the days since the closure announcement, Grady has offered jobs to a range of Atlanta Medical Center employees, from physicians and nurses to housekeeping and security staffers.
David Patton has lived in Atlanta's Old Fourth Ward for 30 years and said Atlanta Medical Center has been a big part of his life.
His grandfather died in a nursing home on the campus, he has gotten care at the ER, and his son took swimming lessons at the hospital's athletic club, all while he has seen the neighborhood transform from a "forgotten" part of the city to one that's become a lightning rod for new development.
"It boggles my mind that an institution like that would just shut down virtually overnight," he said.
This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.