Report: Georgia nearly last in health insurance coverage, trailing Southeast

A new report recently released by a leading Georgia medical university ranks the state among the worst in the nation for health insurance coverage.

Georgia ranks 49th in the U.S. for residents without health insurance, according to a report from Augusta University.

The Institute of Public and Preventative Health this month published its second Healthy Georgia report, which compares Georgia to the rest of the Southeast and the country on 24 metrics. On insurance coverage, the Peach State lags the other 11 states in the Southeast by nearly 3 percentage points and the country overall by nearly 5 percentage points.

A major reason, say experts, is because Georgia has not expanded Medicaid.

For Georgians under the Federal Poverty Level, the rate of insurance is about 9 percentage points lower than the rest of the Southeast. Those residents in Georgia often end up without insurance because of strict Medicaid requirements. If residents are not low-income parents, pregnant, aged or disabled, they may not qualify for Medicaid no matter how low their income is — and Affordable Care Act subsidies only apply for those making more than 100% of the Federal Poverty Level.

"There is a huge chunk of people that just don't qualify for any type of affordable health insurance," said Whitney Grigg, health policy analyst at Georgians for a Healthy Future.

The Healthy Georgians report includes 12 states in the Southeast. Five have expanded Medicaid to cover all residents up to 138% of the federal poverty level.

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Health care in Georgia in flux

Later this year, two things will happen that may impact Medicaid.

As of April 1, for the first time since the COVID-19 pandemic struck, Medicaid in Georgia can ask recipients to re-apply for coverage and remove people who no longer qualify for coverage. For example, women who were covered by Medicaid because they were pregnant may have remained on the coverage even after giving birth but soon will no longer qualify. Griggs estimates that about 500,000 people currently on Medicaid will no longer qualify.

"Medicaid unwinding means ... 2.7 million Georgians have to reapply for benefits," said Georgia House Minority Leader James Beverly, D-Macon. "That starts April 1. There is no community outreach whatsoever to tell people that this is happening."

Kemp's office said that they are working to keep Georgians informed.

"(Department of Community Health and Department of Human Services) have been hiring and training new staff in preparation for the re-determination process and are taking several measures to keep Georgians informed on the process," wrote Garrison Douglas, spokesperson for Gov. Brian Kemp, in an email.

The other major change to Medicaid will come July 1, when a new, limited Medicaid expansion alternative backed by Kemp called Georgia Pathways will roll out. It will cover Georgians making up to 100% of the FPL who do 80 hours per month of work, volunteering or attending school.

Theoretically up to 345,000 Georgians would qualify, a number cited by Kemp in his State of the State address this year, but the number actually covered will likely be lower.

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"For a variety of reasons, we anticipate that the number of Georgians who are likely to enroll will be around 90,000," Douglas wrote. "Georgia Pathways is a program that gives the state the ability to expand Medicaid coverage while not forcing over 200,000 Georgians off their private insurance plans."

Most states have expanded Medicaid to those making up to 138% of the federal poverty level, which does overlap some with the Affordable Care Act subsidies for private insurance. Those in this bracket who do insurance would be transferred to Medicaid if the state expanded up to 138%, said Griggs.

Beverly says that just the interest of Georgia's more than $6 billion surplus could cover insurance for all Georgians, and said that the Pathways program will also not qualify for all the federal incentives that a full expansion would provide.

"It's a dereliction of duty, and it's financially irresponsible for the governor," he said. "It's going to cost more for the waivers. And quite frankly, it's going to cover less people."

Medicaid is not the only way people may get insurance, of course, and Douglas also pointed to other efforts Kemp has backed to make insurance more affordable, including a re-insurance program that protects providers from major claims. According to Douglas, for the current fiscal year this reduced premiums by about 12.4%.

"The state Senate also passed the governor's bill giving the state the ability to establish a state-based exchange for healthcare coverage," Douglas wrote, allowing for its own platform to let residents buy insurance. "This would allow the state to be innovative in its approach to improving consumer outreach and marketing, as well as have more freedom to tackle state specific needs."

Hispanic residents lag other states significantly in coverage

There is one other factor besides Medicaid that Biplab Datta, assistant professor in the Institute of Public and Preventative Health at Augusta University and one of the lead researchers behind the report, thinks may contribute to the low numbers.

"Race wise, if we look at the Hispanic population of Georgia, they have a significantly lower rate," he said. "I think that can contribute to the overall rate as well."

Only 61.7% of Hispanic residents in Georgia have health insurance, according to the report, while across the Southeast it is 73.6% and across the country it is almost 78%. Why is unclear.

"There's nothing currently in my mind that sticks out to me about why the Hispanic population in Georgia would have a higher uninsured rate than Florida or North Carolina, or you know, Alabama or Tennessee," Griggs said.

Datta, for his part, did not know why. It's an issue for future research, he said.

"If you think of public health as a big puzzle ... this (report) is very few of the corner pieces of the puzzles you can easily put in," he said. "But the challenge is to figure out what are the middle pieces."