COLUMN: No Reprieve for Health Insurance Crisis in Rural Georgia

The following article is an opinion piece and reflects the views of only the author and not those of AllOnGeorgia.

In January of 2019, I wrote a lengthy column detailing the lack of private insurance options available to Georgians in rural areas. As a resident of Bulloch County, my focus was on the fact that only those who work for a local government, the state of Georgia, or the federal government could purchase health insurance from reputable providers after Blue Cross Blue Shield of Georgia decided it would no longer offer plans to individuals who are self-employed or work somewhere where group insurance plans are not an option (i.e. – small businesses). The debauchery started during open enrollment in late 2018 and erupted in 2019 when I learned that neither the hospital nor the providers were in-network with the subsidized plan I was eligible to purchase. Here we are two full years later and not a single thing is different. 

Bulloch County is unique to neighboring counties, but not an anomaly on the state level. As a college town, Georgia Southern, East Georgia State College, and Ogeechee Tech employ thousands of people who are covered on plans not available their group, joining municipal, county, state, and federal employees, the sizable population on Medicaid and Medicare, and all those students who have insurance plans tied to their parents and their permanent residences from wherever it is they came.

In 2019, the only option was Ambetter by Peach State, available through the Health Insurance Marketplace under the Affordable Care Act. Most primary care physicians and OB/GYNs, East Georgia Regional Medical Center – which is located IN Bulloch County, blood labs, and other services were all out-of-network. The closest hospital in-network was Optim Medical in Screven County, which offers limited emergency room services, and after that, it was the 55-mile highway trip to Savannah. I recall my bewilderment when I found an in-network OB/GYN who told me that in the event I decided to have a baby in 2019, I could see the doctor over the course of the year, but would have to go to another hospital with another doctor for delivery. 

Thankfully that was not something in the cards for me at that time and while the hospital did eventually work out an agreement with Ambetter on coverage for women in labor, the program was appropriately donned ‘Amworser’ by anyone who had the unfortunate privilege of using it. One doctor’s office actually told me to drop my insurance, get Medicaid – something I don’t qualify for-, and come back. 

In 2020, the options expanded to Ambetter by Peach State and CareSource – both Health Insurance Marketplace plans. Ambetter still had not worked out an in-network plan with the local hospitals and providers and CareSource was presented as the supposed solution to ‘Medicaid is better but I don’t qualify’ problem. You could see providers, but services weren’t actually covered, deductibles were high, and it was still a private insurance-level price. (That’s because it is the Medicaid plan for those who cannot afford it or who have a partial subsidy) Like many others who had Ambetter in 2019, I went with CareSource – which is basically catastrophic coverage with the perk of generic drugs at almost $0. The kicker: the one medication I do take is not covered and is more per month than the monthly premium for the coverage.

Seeing absolutely no benefit in having coverage, halfway through 2020 I decided to drop my CareSource plan and wing it. Of course that came with its own risks and it’s possible that the forthcoming political environment will once again mean no coverage is accompanied by a penalty, but for 2020 it made sense. 

It’s also optimal because providers don’t let you pay cash prices for services if you have insurance coverage – even if that provider doesn’t accept the insurance you have. 

Of course, some providers do not accept uninsured patients at all, as is their right, which only perpetuates the vicious cycle: Requiring insurance to be a patient but not accepting the insurance plans available because the reimbursement rate is so terrible, leading to prices hiking up even more to account for the lack of payment or partial payments, which leads to insurers backing out or covering less because of the high cost-low return formula, thus inflating coverage premiums and once again putting consumers in a position to say ‘Isn’t ‘no coverage’ a better deal than this?’ 

This is a reality for thousands of rural Georgians not because of pre-existing conditions, or an inability to pay, or a lack of providers. But rather the zip code and the county one calls home. Private insurance not backed by or subsidized by the government – federal or state – is available one county over, with plentiful options for plans, patients, and providers.

But for now it remains broken in Bulloch County. Broken from decades of government regulation, manipulation, and intervention that is supposedly going to be fixed by more government regulation, manipulation, and intervention by the respective political paradigms – all of which have pledged to resolve the problem since at least 2010 but miraculously (that’s sarcasm) never have. No amount of court rulings or political promises will remedy quickly enough the problem that is burdening communities right now. 

Leaving the county for healthcare services when you live in a relatively larger metropolis like Statesboro is an outrageous concept to comprehend when you think about how smaller counties with smaller populations and fewer resources – looking at you Candler, Evans, and Tattnall – haven’t been forced into similar situations. 

‘Shop local,’ ‘buy local,’ ‘stay local’ is the message, but the conversation about how we are diverting paying patients out of the county to other providers simply isn’t being had. 2021 will be year three of no private health insurance companies working here, and yet, it remains a passive issue that is mostly unnoticed by those who can do anything about it.

Why?