By Greg Bluestein

Struggling hospitals could scale back their services under a plan unveiled Wednesday by Gov. Nathan Deal meant to help rural communities keep healthcare facilities open.

Deal's plan involves a "step-down" that clears the way for ailing hospitals, and those that were recently shuttered, to offer only more limited services such as emergency care.

"Communities should not have to go without crucial services -- many of them life-saving -- simply because they don't fall within a certain zip code," said Deal.

The fate of rural hospitals has been on the minds of lawmakers this session, which ends on Thursday. Four rural hospitals were shut down over the last two years, and four others have closed their doors since 2000.

Healthcare activists worry more could be shuttered because of Gov. Nathan Deal's rejection of the Medicaid expansion under Obamacare, which the governor views as far too costly in the long run.

The move comes after state Rep. Sharon Cooper sparked debate in January when she said that some faltering rural hospitals with few patients need to close and instead rely on regional hubs. She walked back those comments after fierce backlash, but her remarks underscored the ongoing struggle over rural healthcare.

Deal, who has offered a separate bailout of safety-net hospitals, has been developing this down-sizing plan over the past year. He is endorsing administrative changes, but left the door open for legislative proposals aimed at helping rural healthcare systems in 2015.

(c)2014 The Atlanta Journal-Constitution