The state of Georgia has pulled the plug on a Medicaid waiver program that would have dipped the state’s toes in the water of increasing the number of Georgians covered by the federal program. While not referred to as a “compromise” the program did lie in the political realm between full Medicaid expansion as envisioned under the Affordable Care Act and those diametrically opposed to the program as well as well as anything that expands federal influence.

The pilot program was proposed by Atlanta’s Grady Memorial Hospital, and would have also involved Memorial Health in Savannah as well as “a small group of rural hospitals” in the initial phase, according to a report by Andy Miller in Georgia Health News. Officially, Georgia’s Commissioner of the Department of Community Health Clyde Reese cited “significant costs to the state” as the reason to maintain the status quo.

Miller also notes the Commissioner said federal officials had indicated they were not willing to approve the program unless Georgia also agrees to Medicaid expansion as outlined under the ACA. That’s unlikely to happen anytime soon.

Which leaves us where we are with too many real issues in politics and governance. Ideologues have staked out turf on extreme ends of an issue. Those who are forced to try and solve problems in the real (non-political, non-academic) world are shot at from both sides, while problems linger and grow.

The problems of Georgia’s rural healthcare network have been well documented. While some facilities lack a population base to achieve required economies of scale to satisfy an economic model, almost all face the same problem: Too few patients pay the actual costs of providing services. Only one in five patients in many rural Georgia hospitals are private pay patients. Hospitals generally lose money on all patients who are covered by Medicaid or Medicare, or are uninsured.

The problem is not one isolated to rural Georgia. Southern Regional Medical Center in South Metro Atlanta declared bankruptcy in July. A non-profit foundation will attempt to restructure the hospital in order to keep it serving residents of Clayton County and the surrounding area. While partisans fight, Georgians choices for health care providers are being reduced.

Those on the left believe they have the upper hand, so long as they’re willing to overlook the problems caused by continuing closures of hospitals and doctor’s offices in rural and poor areas. They know that when the problems get bad enough, policy makers will eventually succumb to the argument that Georgians are paying taxes into a system but not getting benefits residents of most other states are taking out.

Those on the right point to the hundreds of millions in state tax dollars that would be added to Georgia’s roughly $3 Billion spent on this “federal” program. These costs, of course, are well above original estimates of the state’s burden from when the program was passed, which raises healthy skepticism of what Georgia’s true burden of expansion will be. Especially when the Federal Government is forecasting deficits in perpetuity.

In between the left and right we have a proposal that would have largely allowed loosening of restrictions of existing Medicaid money, with the goal of serving additional patients using currently appropriated federal funds. That would mean serving more people with no additional federal money and fewer federal strings.

The left has balked because they believe they have a winning hand, and their goal is to have all states under the same program, with the same rules. If nothing else, it’s a way to force an end to opposition to a controversial program.

Those on the right believe this is still an expansion of a federal program, and have threatened lawsuits under a bill passed in 2014 that requires the General Assembly’s approval before Medicaid can be expanded in Georgia. It seems that making an existing program more efficient is an equal abomination to accepting additional federal dollars. This makes sense if you believe the “conservative” position is to end government, and that making the government we have work is contrary to your principles.

Caught in the middle are Georgians that are our most vulnerable. They will travel farther to receive their medical care, but will bring their inability to pay with them.

Georgians can decide to remain in their political corners and watch this happen, or they can decide it’s time to find middle ground and solve the problem. For if they do not, it may be their doctor or hospital that is the next to succumb to a broken business model that doesn’t provide reimbursements for the cost of patient care.

Charlie Harper, author and editor of the Peach Pundit blog, writes on Georgia politics and government; www.peachpundit.com