“Going to the doctor is the last thing on people’s minds because they can’t afford it,” she said as she waited for a preventive health care appointment at Medical Associates Plus@Belle Terrace clinic. “And even if you go, you can’t afford the prescription.”
Georgia is particularly bad at providing care for low-income people, ranking 45th among states rated, according to a report out today from The Commonwealth Fund. The report found there was a wide gap between states, as much as a fivefold difference in some measures and that there is a wide gap in care and results between low-income and high-income populations within states.
Low income was defined as less than 200 percent of the federal poverty level, or $22,980 a year for a person or $47,100 annually for a family of four. Those people often are uninsured or underinsured if they have to spend a high proportion of their income on health care, which was about 55 percent of the low income population in 2010-11, or 57 million people, according to the report.
The chance to enroll in health insurance through the Affordable Care Act, which begins Oct. 1, will help to address some of these problems, said Commonwealth President David Blumenthal.
“We’re really at an unprecedented moment in the history of our country,” he said. “We have the potential to raise the bar, unite the country, and realize the promise of more equal opportunity to thrive by expanding health care coverage and innovating to find the most effective ways to deliver high-quality safe care for everyone.”
But because Georgia and many other states will not expand Medicaid coverage next year, and people under the federal poverty level cannot receive subsidies to purchase insurance through the state exchanges, it sets up a bizarre paradox for the poorest in the state, said Cathy Schoen, the senior vice president and lead author of the report,
“You will have too little income to qualify for help,” she said. “We’ve never been in this situation in the United States before.”
Medicaid coverage would allow the state to begin addressing disparities in health between low and high incomes, Blumenthal said.
“Medicaid is a lifesaver for low-income Americans with poor health status,” he said.
Income in Georgia clearly affects the ability to receive care, the report found. About 22 percent of Georgians and 36 percent of low-income people in the state reported in 2011 that they had gone without care in the past year because of the cost, compared with 16 percent nationally, which was the third-worst rate in the country.
The state ranked 46th for the number of people ages 18-64 who were uninsured and 40th for the number of children who received both a medical and dental preventive visit in the past year.
Quite often the people receiving poor care are in working families, Schoen said.
“This is the workforce that we’re putting at risk,” she said. If that population can now have access to insurance, “we could be taking leaps forward.”