As 2021 draws to a close, Georgia ranked 50th this year, ahead of only Oklahoma and Mississippi in health care. The Medicare Guide on senior health care analyzed prescription drug prices, the number of physicians in relation to the state’s population and life expectancy. Georgia ranked 51st in access to care. One problem with access to care is that many rural counties lack physicians. Nine of the 159 counties have no doctors. Seventy-six counties have no OB/GYNs and sixty counties have no pediatrician. In health outcomes, Georgia ranks 47th, particularly due to infant and maternal mortality rates. Inequities in care and access to care impact the low numbers on health outcomes.
Georgia Demographics
As of 2021 Georgia had a population of 10,830,007 citizens. This increased 18.3 % from the 2010 census. Georgia has the 10th fastest growth rate. Although all of Georgia is not growing. The counties with the highest growth rates are grouped together along the southeastern border and along the northern border in and around the capital of Atlanta. However, there are declining populations from the southwestern border through middle Georgia to the mid-eastern border of Georgia. Georgia has a 15% poverty rate. As of 2021, Georgia’s population under 18 is 23.6%; the population over sixty-five is 14.3%. Eight percent of Georgians under age 65 are disabled.
Rural Georgians’ Access to Healthcare is Failing
Rural South Georgia is becoming a healthcare desert. Citizens who live in rural Georgia have a higher rate of poverty, unemployment and are more likely to be uninsured. Also, as the population of these counties is shrinking, hospitals must cover more uncompensated care. Even for those with Medicare of Medicaid coverage, the reimbursement rates for Medicare/Medicaid are lower than for private insurance. Rural hospitals and rural health care providers often cannot financially continue to operate. In 2021 Southwest Georgia Regional Medical Center closed its 25 bed hospital due to financial strains worsened by COVID-19. Northridge Medical Center, a 90 bed hospital in Commerce Georgia closed after seven years. Since 2010, Georgia has closed six other rural hospitals.
Georgia is One of 12 states that have not expanded Medicaid under the Affordable Care Act
As of May 2020, 13% of Georgians were uninsured. Georgia has the fourth highest uninsured rate in the U.S. Under the current Medicaid program, Medicaid covers minor children up to 133% of the poverty level (higher poverty rates for children five and under); pregnant women with family income up to 220% of the federal poverty level; and parents of minor children with family income up to 35% of the federal poverty level. Non-disabled adults without dependent children are not eligible for Medicaid regardless of income.
Georgia has elected to not expand its Medicaid program under the Affordable Care Act (ACA). Georgia has proposed legislation that would allow the state to expand Medicaid, but only for those earning up to 100% of the poverty level and who work at least 80 hours per month. State Medicaid expansion under the Affordable Care Act has no work requirement and allows coverage for people earning at 138% of the poverty level. Georgia requested a Medicaid waiver from the Centers for Medicare and Medicaid Services (CMS). This month CMS rejected Georgia’s work requirement for Medicaid eligibility. The waiver request also includes a request to replace the healthcare.gov marketplace with an insurance portal privately run by insurers. That is still under review.
If Georgia were to fully expand Medicaid under the ACA, the state would be guaranteed 90% federal funding and an estimated 600,000 people would gain coverage. Instead, the state’s waiver plan would cover only about 50,000 more uninsured Georgians with no additional federal funding. Currently, Georgia has 2,159,944 residents covered by the Medicaid/CHIP program. An additional 678,000 residents would be covered under Medicaid expansion under the ACA. An estimated 269,000 residents have no access to health insurance. By not expanding Medicaid, Georgia is turning away $3.5 billion in federal money available for the expansion.
Record Numbers Signed up for ACA Health Insurance
A records 13.6 million Americans signed up for health coverage for 2022 on the Affordable Care Act marketplace. Increased government subsidies, which lowered out-of-pocket costs, accounts in part for the surge in enrollment. Georgia signed up 653,990 enrollees from November to December. Enrollment under former President Donald Trump stagnated when his administration cut tens of millions of dollars in funding.
COVID-19
As of December 2021, Georgia had fully vaccinated 50.95 of its citizens. The US vaccination rate is at 60 percent. According to the Georgia Department of Public Health daily status report, one point four million Georgians have had confirmed COVID-19 or its variants. Over ninety-three thousand Georgians were hospitalized with COVID-19. More than 25,000 Georgians have died of COVID-19 since the pandemic began.
The Omicron variant this month drove 20,000 new COVID cases reported. Metro Atlanta has the highest rates of infection. Six hospitals in metro Atlanta jointly announced increase of 100-200 percent for COVID hospitalizations – the vast majority being unvaccinated. Governor Brian Kemp authorized the National Guard to assist hospitals and vaccination/testing sites.
COVID created health worker shortages in nursing staffs at hospitals and for caregivers for persons with disabilities as well as personnel at state-run psychiatric hospitals. Georgia operates five psychiatric hospitals (Georgia Regional – Atlanta; East Central Regional – Augusta; Central State – Milledgeville; West Central Regional – Columbus and Georgia Regional – Savannah). Ten percent of available beds are unfilled due to staffing issues. The bed capacity problems, worsening during the pandemic, creates backlogs of poor, uninsured and jailed psychiatric patients who cannot get placement in state facilities.
Pending COVID-related health care legislation includes a bill to ease the COVID-inspired restrictions on long-term care facilities over concerns that lock-downs cause facility residents to suffer from isolation and loneliness. The hospital industry opposed the legislation citing concerns about infection spread.
The Georgia Telehealth Act in 2019 widened the availability of telehealth services to Georgia residents which increased telehealth exponentially during the pandemic. During the pandemic, the Act was amended to provide telehealth services from home; approve certain audio-care services; eliminate the initial in-person consultation requirement and ban separate deductibles for telehealth.
The Georgia legislature expanded the list of authorized healthcare professionals who could administer vaccines to include EMTs and cardiac technicians. This applies only during a public health emergency. Finally, the legislature protected businesses from liability suit over COVID-19 exposure.
Finally
As we move into 2022, issues for Georgia residents continue to be access to health care through expanded health care coverage and access to care in our rural counties. Uninsured Georgians would receive access to care and rural health care providers would gain financial resources to aid in stability if the Georgia legislature would vote to expand Medicaid through the ACA. More than any other legislation, expanded Medicaid would bring Georgia out of the bottom ranking in health care. Meanwhile, year two of the COVID-19 pandemic continues with the Omicron variant wild-fire spreading through households – mine included. Vaccines are the best protection from this pandemic. Please consider getting a vaccine and a booster in order to protect your health and to reduce the risk of hospitalization. Stay safe everyone. And have a meaningful New Year.