Slipping between the gaps:

Low-income Georgians struggle to find affordable and accessible health care

Olivia Wakim

The Athens Neighborhood Health Center works to provide affordable and accessible health care to people in Athens-Clarke County and the surrounding counties. This center is located at 675 College Avenue in Athens, Georgia. (Photo/Olivia Wakim)

Jenny Ginsberg’s life has been defined by chronic illness for years. The 39-year-old Bogart resident expected to be a mother by now. She hoped to pass her time writing songs for her band, Like Totally, but a long succession of health issues that grew too debilitating to ignore put her plans on hold. Mountains of medical debt and endless trips to the doctor are a daily reality when Ginsberg’s pain eases enough to function. 

Ginsberg has pages of Google Docs dedicated to explaining her symptoms, describing her diagnoses and recounting the medications she takes. The pages depict a life of unmanageable pain, sleepless nights and pleas to doctors to take her seriously. 

When the worst of her health issues began, Ginsberg said she tried to ignore the pain and continue working her job at the University of Georgia library, but she was missing so many days of work that she realized it would be impossible to continue. However, in order to qualify for long-term disability coverage, she couldn’t quit — she had to be fired to prove she physically couldn’t perform the work.

After finally losing her job in 2015, Ginsberg applied for long-term disability. She was approved in 2018 and later acquired Medicare as her primary insurance and Medicaid as her secondary.

Ginsberg was recently married so she could be covered as a dependent on her husband’s insurance plan. Although the wedding ceremony isn’t until April, Ginsberg’s current medical needs are expensive and life-threatening. 

“It’s just a nightmare if you have health issues and you don’t have money,” Ginsberg said. “If I had money, I don’t think I would have gotten as sick as I had. I would have been able to immediately pay for the best doctors to diagnose me; I wouldn’t have had to go to dozens and dozens of doctors.” 

In the United States, health insurance is a luxury. For those who already struggle to make ends meet, spending the extra money is out of the question. Without health care, adults are less likely to seek preventative care, leading to more severe and expensive health problems.

The extent of Georgia’s problem 

According to the Commonwealth Fund’s 2020 scorecard on state health performance, 15% of adults in Georgia went without health care in the past year because of the cost. It’s difficult to say for sure how many adults in Georgia are uninsured because the number varies from source to source.

“We definitely would hypothesize that people with a more regular access to care, they’re more secure in their health care; it can make them more financially secure, it can increase stability in their lives and that can have a lot of different spillover factors from their health to other ways they interact with society and personally in their relationships,” Jessica Smith, clinical assistant professor in the department of health policy and management at UGA said. 

In general, single, able-bodied adults are not eligible to receive Medicaid unless they become pregnant or develop a disability, Smith said. 

When the Affordable Care Act was enacted in 2010, the federal government assumed all states would expand Medicaid to make up for those who wouldn’t be able to afford marketplace insurance. When the supreme court ruled that states could choose individually whether they expanded Medicaid, it created a coverage gap. 

In Georgia, to qualify for Medicaid, a person must make less than 35% of the federal poverty line, according to the Center on Budget and Policy Priorities. The federal poverty line is $13,590 a year for a household of one, according to the HHS Poverty Guidelines for 2022. If Georgia were to fully expand Medicaid, people earning up to 138% of the federal poverty line would qualify for Medicaid. 

Georgia is one of 11 states that has not fully expanded Medicaid. As of 2021, it’s estimated that 14.7% of Georgians under the age of 65 were uninsured, according to the U.S. Census Bureau. Additionally, the Covering Georgia Coalition estimates that around 240,000 Georgians living in the coverage gap would be eligible for health insurance if Medicaid were fully expanded. 

Graph depicting 2021 estimates of uninsured adults by state. Sources: American Community Surveys & Kaiser Family Foundation

One of the biggest harms of going without health insurance is delaying care when you need it, Smith said. Ignoring seemingly insignificant concerns and neglecting check ups can exacerbate health conditions to the point of emergency. When patients show up to the emergency room, they often require more intensive and costly care that goes uncompensated because they can’t afford to pay. 

Uncompensated care drains a health system’s resources, especially if they don’t receive a diversity of uninsured and insured patients, Smith said. 

“It’s much better for the hospital to be able to at least get reimbursement from Medicaid or some provider in order to cover those services that they’re providing,” she said. 

The problem doesn’t just lie in narrow Medicaid eligibility; it’s often difficult for those with Medicaid insurance to find providers who will accept their insurance plans. 

“The reimbursement rates for Medicaid are so low compared to private insurance and then even compared to Medicare coverage,” Smith said. 

According to the American Hospital Association, in 2020, hospitals received only 88 cents for every dollar spent on caring for Medicaid patients. 

States individually establish policies on Medicaid reimbursement rates as long as they stay within a maximum and minimum established by the federal government, according to the Center for Medicare and Medicaid Services.

“If [the state] would be able to increase reimbursement rates that they offer providers for seeing Medicaid patients, they’re going to be more willing to have more of those patients in their practice,” Smith said. “If there’s not an incentive and the reimbursement rates are not there, [providers] don’t really have any kind of motivation to see those patients.”

Affordable and timely health care

Ginsberg said she has been waiting to get five teeth extracted since April 2022. Her current pain medication, Buprenorphine, manages her pain but has a side effect of tooth decay. Ginsberg said she started losing teeth “left and right” after taking the medicine. 

“I wouldn’t have been able to do what I’m doing now without the medication I found this year because it made me a lot more stable and better able to function in life,” she said. 

As a result of medication that allows her to function, she needs five teeth removed, a procedure she estimates would cost about $15,000. Since it’s an emergent, life-threatening situation, she will need to be hospitalized for the procedure, but according to Ginsberg, Medicaid and Medicare won’t cover her hospitalization for dental work unless it’s for jaw cancer. She hopes that being dependent on her husband’s insurance will ease the high cost of the surgery, but she is still struggling to get an appointment. 

All the while, she tries to maintain a steady stream of antibiotics to prevent the pain from becoming unmanageable. 

“I have a wedding in April, and I want to be able to smile for it, and I’m scared I won’t be able to and it’s already been a year that I haven’t been able to smile,” Ginsberg said. 

Jennifer Richardson, director of marketing and outreach at the Athens Neighborhood Health Center, and Almena Smith, revenue cycle manager, understand the need for accessible and affordable health care better than most. 

Almena Smith knew ANHC was where she wanted to work from the moment she walked in for her interview 24 years ago. Richardson has been there even longer, boasting 27 years of service at the ANHC. 

The health center serves a vital role in Athens-Clarke County and surrounding counties. 

“We’re probably one of the only Medicaid providers in town. A lot of providers don’t see patients with those insurances,” Richardson said. “But then on top of that, we still have our other people with the other insurances who come here and who have made this their medical home.”

ANHC is a federally qualified health center. Among other things, FQHCs qualify for enhanced Medicaid and Medicare reimbursement, serve an underserved area or population and offer a sliding fee scale for services, according to

ANHC patients without health insurance pay a nominal fee for services. They must bring proof of income or a wage statement from the unemployment office to receive discounted care. 

The clinic offers a comprehensive amount of medical services, like general practice, pediatrics, chronic care and a 340B pharmacy which provides low-cost medications to patients. ANHC can even help with transportation needs to assist with keeping doctor appointments. 

“The object of community health centers is to provide a medical home for people, because you want them to be consistent and seeing the same provider who will know their history and better take care of them,” Richardson said.

Expanding Medicaid would allow the ANHC to get paid for treating patients they otherwise wouldn’t be paid for, Richardson said. It would allow them to expand their operations, open more clinics, hire more providers and care for more people in the community. 

“We try to reach them all,” Almena Smith said. “We can’t always do, but we work with the ones who we can reach and we make sure and let them know, your health is more important.”

For a list of some low-cost health care resources in Athens, check out the post below.