Every week for the past nine years, Good News Clinics volunteer Ron Stowe has listened to Hall County residents explain how they became uninsured.
“There are those people that have made some bad choices, but I don’t see many people walk through the doors that are here because they want to be,” Stowe said. “These are people that just can’t live a normal life and they have no money to do otherwise.”
Stowe volunteers as an eligibility specialist at the Gainesville clinic that serves low-income residents without health insurance.
Lives on the line
This special weeklong series explores how cost and bureaucracy stand between local residents and their health care. Times reporters pored through the latest Community Needs Health Assessment, conducted numerous interviews with those in the local health care industry and those affected by it and examined the latest efforts by state government and politicians to remedy problems in our health care system. Read other stories in the series at gainesvilletimes.com/livesontheline.
The 2019 Community Health Needs Assessment of Northeast Georgia reported 14% of people in Northeast Georgia Health System’s primary service area are uninsured. The service area includes Gainesville, Gillsville, Lula, Clermont and Murrayville ZIP codes and totals 157,458 people.
Most of that population, 46%, are insured through employer-sponsored health coverage, and the remainder of the population is divided between Medicare at 15%, those who purchase coverage through the private health insurance marketplace at 11%, people on Medicaid at 14% and the uninsured.
In the needs assessment report, Habersham Medical Center — whose primary service area includes Rabun, Habersham and Banks counties — showed the highest percentage of uninsured at 18%. The NGHS Braselton service area displayed the lowest percentage of uninsured at 10%. The Braselton area included ZIP codes for the Flowery Branch and Oakwood portion of Hal; and Banks, Barrow and Jackson counties.
Georgia’s percentage of uninsured is 17% for a population of 10,467,269.
Good News Clinics, NGHS and the Hall County Health Department work together to serve the uninsured in Hall.
Unlike the others, Good News Clinics solely serve Hall’s uninsured population and do not request or accept payment.
The clinics treat upward of 3,000 people without insurance annually, with a roster of doctors providing voluntary services. The nonprofit receives its funding through donations.
To be eligible for Good News’ services, applicants must be uninsured Hall County residents with a household income at or below 150% of the federal poverty level. That would be $38,625 for a family of four.
Waiting and praying for Medicare
Liz Coates, the nonprofit’s executive director, said in 2018 the clinic saw 3,544 patients. Good News’ largest demographic includes those in their late 50s to early 60s.
“A lot of the time we’re just filling the gap,” Coates said. “We see so many people in the early 60s range that have a health concern that’s preventing them from being able to work full time and keep benefits. They’re praying for 65 to get Medicare, but luckily they don’t have to pray hard because we’re there.”
Stowe and Kathy Carter, who both volunteer at Good News, said this is one of the most common situations among the clinics’ patients.
Carter said many who fall into this category have worked all of their lives and now rely on Social Security as their only means of retirement. The $400-$500 a month they receive isn’t enough to afford health insurance.
Adetunji Adenuga, a 64-year-old Hall resident, looked to Good News to help him.
Three years ago he had major heart failure, but he was too at risk to undergo bypass surgery because of kidney and liver problems.
“I ended up at Northeast Georgia Medical for almost three months,” he said. “I had so many problems, and they couldn’t do anything with me. During my stay there, I was wondering whether I’m going to survive or not.”
Adenuga said his doctors at NGHS advised he go into hospice care; however, the closest place with an opening was in Macon.
Luckily, the hospital steered him to Good News Clinics.
For the past three years, Adenuga has been able to live on his own and pay regular visits to the clinic.
Adenuga said he was taken aback at how much the doctors and staff at the clinic care for him.
“I’ve been to hospitals and clinics where you’re just a number,” he said. “They take the time to know your name and situation, and they take the time to help you.”
Even when he doesn’t have enough money to buy a cab back home, someone lends a hand.
Adenuga said although he doesn’t know when or how, one day he plans to repay those at Good News Clinics for their service.
“It was Good News Clinics and God that really brought me back to health,” he said. “It was three years ago that they told me they’d put me in hospice care. Now I see Eva (Johnson, a nurse practitioner) only every three or six months because my situation has improved.”
3 more reasons people are often uninsured
In addition to those waiting to get on Medicare, Stowe and Carter said they see three other major categories of patients at Good News.
The second group includes people struggling with poverty. Stowe said many of these people were born into a poor family, dropped out of school or are having trouble financially supporting a family on their own.
The working poor make up the third category.
“They have a job, but are working for a company that would maybe only give them 30 hours a week with no benefits,” Stowe said. “
Carter said the last major group of people she comes across are people who are too injured or ill to work. They end up losing their job because of their poor health.
Coates said these patients either don’t qualify for disability insurance or they’re waiting to receive it.
“Disability is incredibly difficult to get, and it can take a very long time,” she said. “Just because you don’t qualify for disability, doesn’t necessarily mean you are capable of working.”
Coates said Good News has a 62-year-old patient who falls into this category. The lady was experiencing severe hip, knee and back pain while working at a grocery store.
Because of her injuries, she fell on the job several times.
Coates said her boss asked her to retire because she couldn’t physically meet the demands of the job.
“When she retired, she lost her health insurance and had five more years before Medicare,” Coates said. “She’s too disabled to work, but doesn’t qualify for disability.”
Carter describes cases like this as a “vicious cycle.”
“I do see people that I went to high school with who were the most popular that come through these doors,” she said. “Some people get laid off and they just go one month without insurance. It’s very humbling to come through these doors.”
In November, Stowe helped a patient who started having seizures. His boss laid him off until he could get the proper medication and control his seizures.
“He took his last paycheck and got a room in one of these budget motels,” Stowe said. “He, his wife and three kids are living in that room. Situations like his aren’t typical, but they’re also not uncommon.”
Carter and Stowe said they have seen a common trend during their years at Good News.
“We have a big percentage of companies in Hall County that pay minimum wage and don’t provide health care insurance,” Stowe said.
Carter speculates that these companies allow their employees to work 30 hours a week, so they can remain in the part-time category, bypassing insurance.
Dave Palmer, public information officer at the District 2 Public Health Department, said he finds that affordability hinders many people from getting health insurance.
“Are you going to pay the rent or buy health insurance?” Palmer said.
Coates said from her experience, even though people may be able to afford a premium, the high deductibles become a huge deterrent.
Cooperation is key
With Good News working alongside the health department and NGHS, Coates said none of the groups want to duplicate their offerings with the uninsured.
Moore said the health system helps Good News as much as it can, including offering financial support for the nonprofit’s operation needs. In 2018, the health system donated over $560,000 to help Good News Clinics provide care to its patients.
“They do a really great job of providing a home for so many of the community’s indigent population,” Moore said of the health services the clinics provide.
Beth Downs, NGHS manager of marketing and public relations, said 172,812 people visited the hospital’s emergency department in 2018. She said 13,790 of those were patients who received indigent/charity care and were discharged.
NGHS spent $63.9 million on indigent and charity care between its Gainesville and Braselton location in fiscal year 2018.
Stowe said all of the doctors at Good News are primary care physicians. However, the clinic also offers assistance through Health Access for those needing a specialist.
Health Access provides specialty care referrals, diagnostic tests and treatment for uninsured patients referred by primary care providers, including the NGHS’s practice at the health department and Good News.
Although Good News has a basic immunization program, Coates said they often refer people to the health department, which offers a wider range of immunizations.
Good News also doesn’t provide prenatal care because in Georgia an expecting mother meeting income qualifications would be eligible for Medicaid. The nonprofit refers expecting mothers to the health department.
“It’s about collaborating, so that we’re not duplicating services and so we’re not missing any demographic,” Coates said. “Once the barrier of access to health care is removed, people still have to learn how to navigate it.”
Navigating the system
Christy Moore, manager of community health improvement at NGHS, said many times the uninsured patients she encounters are eligible for programs like Medicaid or disability insurance.
The health system has navigators whose job is to help patients figure out which financial resources are available to them, whether they need to go through Good News or not.
“Either they don’t know they could have that coverage, or they have great difficulty applying for it,” Moore said. “That’s where those navigators come in.”
In other cases, Coates said people just don’t know where to start when it comes to looking for health insurance. This can especially prove challenging for non-native English speakers.
About 28% of Hall’s population and more than 40% of Gainesville’s population are Latino, according to 2018 census reports.
Around 40% of Good News’ total patients are Latino. Coates said Good News is full Spanish-English bilingual in its medical and dental clinics, and also has a full-time bilingual counseling department.
“I’m thankful that there’s the Hispanic Alliance,” Coates said. “I’m glad they’re trying to educate people and have the health fair to explain and sell insurance.”
Vanessa Sarazua, executive of the Hispanic Alliance GA in Gainesville, said within the area’s Latino population, she sees issues with not only health access, but health literacy.
The Hispanic Alliance works to bridge those gaps through providing screenings at its annual health fair and educating people on what’s available in the area.
“Between the language barriers and poor literacy, we see sometimes a gap in our community as well as not getting Medicaid for children due to fears of repercussions in their applications for immigration and immigration statuses,” Sarazua said. “Those are the gaps we’re trying to fill.”
Children who are citizens and fall within the state’s family income eligibility rules, qualify for government aid in Georgia — even if their parents are non-citizens.