Athens residents, among the poorest in Georgia, are healthier than anyone would expect.
The poverty is well known. Clarke County has the seventh highest poverty rate in the state out of 159 counties. Nationally, Athens contains the fifth highest poverty rate among counties with populations higher than 100,000 people, according to recent census data.
And, experts say, that with this level of poverty comes poor health. This is the outcome for most counties in Georgia. Nearly 80 percent of Georgia’s counties with high poverty rates contain health statistics that match up just as poor.
But, a new study shows just the contrary for Athens. Clarke County ranks 14th for the best health rates in the state. They sit just above Henry County who oppose Clarke with the eighth lowest poverty rates.
An assembly of experts offered a range of explanations as to why these statistics contest one another. They include: a UGA Public Health professor, the state’s most well-known demographer, a volunteer physician, and an office manager at a health clinic for the underprivileged.
Three primary explanations from experts:
- Athens is a young town with a small percentage of the population 65 years or older, which lowers the mortality and morbidity rate.
- Athens has a large number of highly educated people who make smart health decisions.
- Athens is a social and economic hub with two regional health centers that attract commuters. There are also free health clinics that help the uninsured.
Athens is a young town.
Multiple news sources, from CNN to Kiplinger, have ranked Athens, Ga. as one of the top places in the country to retire, yet only 8 percent of the population is 65 years and above. That is lower than the rest of Georgia where an average of 11 percent are in their retirement years. In Clarke County, 74 percent of the residents are between the ages of 19 and 64 years old.
“If you have a population that is on the younger end of things,” said Dr. Monica Gaughan, UGA assistant professor in the College of Public Health, “than you are going to have lower mortality rates because older people are the ones who tend to be sicker.”
The University of Georgia plays a slight role in this statistic; however, only a small percentage of students declare Clarke County as their permanent residence so they do not effect the census results.
Almost two-thirds of UGA students come from about ten counties in the metro-Atlanta area, said Dr. Doug Bachtel, UGA professor of demographics. A significant number of these students drive back and forth from school each day or live in university dormitories.
The facts are simple. Younger people tend to be healthier people. Athens has a significant number of young to middle aged citizens who push the mortality and morbidity rate down; therefore, the overall health rate of the county is elevated.
Athens entices the highly educated.
“Better educated populations are going to live longer and they are going to be healthier while they are living,” Gaughan said. “One of the weird things about Athens-Clarke County is that we have extremely low income levels and extremely high education levels.”
The high school graduation rates of Clarke County are at 66 percent, which is only one point lower than the rest of Georgia; however, there is an overwhelming number of of the population with a bachelors degree or higher. The University of Georgia, located in the center of Athens, obviously plays a part in this statistic. A large portion of the population consists of highly educated professors and professionals, all who contain premiere health insurance and can afford to live healthy lifestyles.
Athens has a bimodal distribution of education and poverty levels, meaning there are large populations of people resting on two extremes of the spectrum. Forty percent of the Clarke citizens have a bachelors degree or above, which is twice the percentage of rest of the state.
“If you aren’t poor in Athens you are actually very well-off,” Gaughan said. “These are the people who are going to have access to good health care. They have money to buy healthy food. Yes, poor people are going to be unhealthy people and they are going to be more likely to die, but if half of the population is extremely wealthy, which is what happens in Clarke County, than they can pull that statistic up.”
Those classified within the 34 percent who live under the poverty line are not all uneducated. Gaughan stressed the necessity to remember the people who contain a college degree, but are voluntarily poor.
“Think about all of the musicians, and the artists and the hanger-oners that are part of Athens,” Gaughan described. “You have the education which will reduce your mortality and reduce your morbidity, but it doesn’t necessarily mean that education is translating into higher income.”
Athens is a medical hub.
Athens is a lively town with shops and shows that people from all parts of the state travel to be a part of. They also commute in for medical care because of the two regional hospitals: Athens Regional Hospital and St. Mary’s Hospital.
“It’s all about the location,” Bachtel said. “There is a large number of state and federal agencies that are headquartered here. You’ve got a large number of people with Blue Cross and Blue Shield health insurance. Plus Clarke County and Athens tends to be a social, retail, service and educational hub in northeast Georgia. That’s why a lot of things cook here.”
About 20 percent of Athens’ residents contain Medicaid. Another 23 percent contain jobs but are still uninsured because they are ineligible for Medicaid and make too little to afford insurance. Most of the private physicians in town refuse to see either type of person, choosing to only care for those on the upper half of the bimodal distribution.
Those struggling in the lower half are not left completely uncared for. A multitude of free clinics are offered through Athens Health Network, an organization committed to filling in the holes of medical care within the health system of Athens. The program started from an umbrella organization through UGA called OneAthens, and then broke off in 2010 to be more focused on underprivileged healthcare.
“Its confusing because most populations have a much more normal distribution than our population,” Gaughan said. “Athens-Clarke County is comprised of extremely affluent, white retirees and professors and professionals, and extremely poor African American people who clean our toilets, and that is the ugly little secret of Athens. These clinics constitute the health safety net in town so poor people, who don’t have insurance, can use these practices to get access to the system.”
The two most popular clinics are Mercy Health Center and Athens Nurses Clinic. Both care for those who are completely uninsured, with no way of paying for health services.
One their main goals, said Dr. Paul Buczynsky of Mercy in a World Magazine article, is to get their patients involved in their own health by educating them on their illnesses. When a patient is treated for diabetes, one of the most perpetual chronic diseases seen at the clinics, he or she is required to take a six-week course that teaches the patient about the illness in order to get a prescription refill. The volunteer physicians highly enforce lifestyle changes over quick treatment so that more patients can be seen over time.
Not a perfect system.
Despite the glowing census numbers, not all experts agree on the accomplishments of Athens’ healthcare system.
Dr. Bachtel feels confident in the success of the services provided by the faith community and free clinics; however, Dr. Gaughan and those at Athens Health Network know the harsh reality.
“We do not have enough resources for the poor,” Gaughan stated. “I think it is a convenient little fiction that we tell each other when we say, ‘There’s so much charity care. Athens is just too busy to hate.’ That’s crap.”
Demand for free healthcare in Athens is rising, according to an AthensPatch article. The clinics are first-come, first-serve, and only have the resources to see a limited number of patients per day, said Mary Baxter, office manager of Mercy.
When the clinics are closed, 75 percent of the patients go to the Athens Regional ER, even though most of their health issues are not emergencies. This increases their wait time and many leave without being treated.
“The poor have pretty hard lives and don’t have a lot of access to care,” Gaughan said. “They go to the emergency rooms which is not necessarily the highest quality of care. If you have diabetes and you are having a diabetic episode than you don’t need to be in the emergency room, you need to be with a physician that has been managing your care. Very few physicians take people who don’t have health insurance, or even take people with medicaid.”
Athens-Clarke County is one of the few places in Georgia who has defied the standard of poor people with poor health rates. However, as seen nationally and locally, there is always room for improvement in the public healthcare system.
Athens Clarke County has a large number of residents that would qualify for the benefits added under the Affordable Care Act, but Georgia’s decision to limit the expansion of these benefits may require Athens to come up with local solutions to the widespread healthcare needs.
As far as how a local Athens Health Assurance plan will address those who will not gain Medicaid under Gov. Deal’s denial of expansion, Alexandria Chambers of the Athens Health Network calls this “the million dollar question.”
According to the U.S. Census Bureau, 22.8 percent of Athens-Clarke county residents are uninsured this is higher than Georgia’s average and the national average.
The Affordable Care Act passed in the summer of 2012, sought to address the access disparity of healthcare to the poor. “The law put in motion the creation of a nationwide insurance system that would sharply reduce the number of Americans without coverage,” reported the New York Times.
Before the Affordable Care Act, Medicaid requirements designated certain categories of need that had to be met in order to receive Medicaid. Though requirements varied by state, common categories included people living with certain physical disabilities or pregnant women and children living below a designated poverty level. Many low-income adults without children and some low-income parents whose children received benefits did not qualify for Medicaid coverage under previous Medicaid legislation.
New legislation from the Affordable Care Act provides Medicaid to all adults who earn up to 133 percent of the federal poverty level, but allows for states to decide whether or not to expand Medicaid coverage to include this entire new population of Medicaid recipients.
Georgia Governor Nathan Deal chose last summer not to expand Medicaid in Georgia. “I think that [Medicad expansion] is something our state cannot afford,” said Deal in an interview with the Atlanta Journal Constitution.
Deal’s decision reflected the beliefs of many other Republican governors at the time who did not believe the federal government would be able to fully provide the funds required for Medicaid expansion in each state.
“If Georgia expanded its Medicaid program according the the ACA, an additional 646,557 Georgians would be eligible for Medicaid by 2019,” said Monica Guaghan an assistance professor in the Health Policy and Management Department at the University of Georgia’s College of Public Health.
“I think that Georgia will continue to have a population that is unhealthier than other parts of the country,” said Guaghan. “The primary reason for this is a lack of political will within the state of Georgia to address social problems related to poverty.”
Some communities are looking to develop local healthcare programs to address the large number of people who will remain uninsured because of Deal’s decision to not expand Medicaid.
In Athens-Clarke County the Athens Health Network was created to provide services for the health needs of the uninsured and under-insured by bringing together multiple healthcare stakeholders in the Athens community.
Under their 2008 proposed recommendations, the Athens Health Network stated a need to “Create the OneAthens Healthcare Plan to serve the primary health care needs of the estimated 14,250 uninsured in Athens.”
Today the Athens Health Assurance program is being developed by executive director of the Athens Health Network Alexandria Chambers.
Chambers calls the Athens Health Networks Health Assurance program a “navigation system,” for those without insurance seeking healthcare services.
This program is not an insurance plan, said Chambers, and patients will still have to pay for the cost of services. What this program is providing is a facilitator between healthcare providers and the uninsured. “We are essentially acting as that broker for services, negotiating a discounted rate for people to pay.”
The Assurance program would provide patients with access to information and guidance on where to get primary care, how much it is going to cost, and how to go about making payments and filling out paperwork.
The Athens Health Assurance program is currently in the early stages of development and funding. The program has filed for nonprofit status and requested grants from partners, including Kaiser Permanente.
Once the program receives the funding it needs, there are three major pieces that must be developed in order to see the Health Assurance program come to term, said Chambers. Developing a network “of [healthcare] providers that would be willing to see our members at a discounted rate,” developing the resources needed to provide member services and implementing operations.
Currently in Athens there are three clinics that provide primary care to the uninsured. One of these clinics is the Mercy Health Center. Executive director at Mercy Health Center, Tracy Thompson sits on the board of the Athens Health Network and fully supports the creation of a health assurance program in Athens.
Thompson explained that the program would best serve the fairly healthy in the working poor population of Athens—to help them get the primary care that they otherwise could not afford. In order to implement a health assurance program in Athens the health network needs, “a few key physicians to buy into the program and good hospitals to buy-in,” said Thompson.
The program will work with people and help them plan for their health needs. People will have a better understanding of cost up front and they will be able to take the necessary steps to financially prepare to address these needs before they develop into debilitating problems that could prevent them from working and being able to afford the healthcare they need, said Thompson.
“Because Governor Deal at this time is choosing not to expand Medicaid coverage here in Georgia we will still have that number of people who would have been eligible [Under the Affordable Care Act] for Medicaid, but will not become eligible because there is not an expansion,” said Chambers. That is the target population the Athens Health Assurance program hopes to help.
If funded and put into action, the Athens Health Assurance plan would also provide a healthcare option for those receiving minimum government subsidies, those choosing to pay the 1 pecent tax and not purchase insurance, and undocumented immigrants who do not receive any benefits.
Just as the development of a local health assurance program is still in development the implementation of the Affordable Care Act is still under debate.
In recent weeks Republican Governors who previously choose to opt out of Medicaid expansions for their state changed their minds.
Most recently New Jersey’s Governor Chris Christie, previously an adversary to the Affordable Care Act, chose to accept the expansion of Medicaid in his state.
This raises the question as to the permanence of Deal’s decision on Medicaid expansion in Georgia and what Medicaid reforms will mean for local healthcare programs—particularly in communities like Athens where health accesses and disparity are prominent issues.