Nearly 1 in 5 women in Georgia of childbearing age,19.3%, has no health insurance, one of the worst rates in the country, according to a study published Wednesday morning by researchers at Georgetown University.
The numbers in that age group were highest among Latina women, of whom nearly half— 45.9% —were uninsured.
“It’s really pretty shocking,” said Joan Alker, executive director of Georgetown’s Center for Children and Families, which published the study.
Georgia has one of the worst records for maternal mortality - women who die from pregnancy - and infant mortality. A study last year by Georgia State University researchers ranked Georgia 50th of 50 states for its high rate of maternal mortality.
Georgia has long struggled in health rankings, and experts say the state’s low level of insurance is one of the reasons why. Without health insurance to pay for doctor visits, people don’t get seen for preventive care. Only when conditions bloom to the point of emergency do they go to the hospital, where emergency rooms must treat and stabilize everyone who walks in the door. And by then, the problem may often be beyond solving.
Something similar happens for women who are uninsured and suddenly able to get Medicaid coverage when they become pregnant, as is the case with low-income women in Georgia.
Medicaid is the government health insurance program for children and some poor adults. In Georgia, Medicaid does not cover most poor working-age adults. But one of the few groups of adults who may receive Medicaid are women who get pregnant. The state recently expanded Medicaid for new mothers from six months’ coverage after birth to a full year after birth.
Some adults may qualify for Medicaid if the federal government declares them disabled, but advocates say many if not most people hampered by mental illness or physical impairment never get declared disabled and thus don’t get health insurance to see doctors.
The insurance barriers in Georgia contribute to the phenomenon of women who aren’t healthy enough when they get pregnant, and don’t have a habit of seeing doctors, advocates say. More than 22% of pregnant women who do get on Georgia Medicaid don’t get timely prenatal care. And the very women most vulnerable in pregnancy - those with conditions like hypertension, diabetes or mental illness - needed to have those conditions managed before pregnancy.
“For women of reproductive age, it’s very important for them to be healthy before they get pregnant, while they’re pregnant, and after they’re pregnant,” Alker said.
Georgetown’s Alker says data show the most effective way to increase the number of women with constant health coverage would be to expand Medicaid to all poor Georgia adults who would qualify under the Affordable Care Act. Georgia is one of about 12 states that have not done that. Alker concedes that the lack of Medicaid expansion is just one part of the puzzle.
Kemp’s office has estimated that about 400,000 Georgians would be covered by a full expansion of Medicaid. A spokeswoman for Gov. Brian Kemp, who opposes full Medicaid expansion, pointed to his support for a more limited “waiver” proposal that might lead to Medicaid coverage to about 50,000 Georgians. The Biden administration and the Kemp administration are locked in a battle over the proposal.
“Governor Kemp has worked throughout his administration to support those most vulnerable,” said his spokeswoman, Katie Byrd, adding other initiatives Kemp had supported to address the health of new moms.
Cynthia Román-Hernández, managing director of family stabilization and well-being at the Latin American Association, has seen that dynamic over and over with patients. It did not surprise her to hear that nearly half of Latino women of childbearing age in Georgia had no health insurance.
Some may be ineligible for Medicaid because of their citizenship status, or because though they are citizens they are adults who haven’t been federally declared to be disabled. Or they may be citizens who qualify for commercial insurance but can’t afford it. Others may be eligible for Medicaid but don’t know it, or face barriers using the technology to sign up.
In any case, the result is the same, Román-Hernández said, echoing Alker: delayed care that causes problems to worsen and burdens whole families.
Román-Hernández recounted the story of a woman who was not a citizen, but had children who were citizens. Without insurance, she had an untreated condition she didn’t know about, and she started getting prenatal care only in the final months of her pregnancy. By then it was too late, and she lost the baby.
The trauma from losing the baby so late caused her mental health problems that also went untreated, Román-Hernández said.
Even if the woman were a citizen, none of the care except the pregnancy care would have been covered by Medicaid. Meanwhile her family of citizens had to deal with the fallout.
“The mentality is, they’re an undocumented woman,” Román-Hernández said. “But this (the baby she lost) is a child that will be a U.S. citizen. There’s no integration on how the health system will take care of that mom.”
Dr. Karen Kinsell runs a clinic in Clay County in rural southwest Georgia. Most of her clients are citizens but also uninsured.
“To have healthy moms, you have to have healthy women,” Kinsell said. “And not helping them be healthy throughout their entire lives tends to make them unhealthy mothers and the children unhealthy.”
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