Subscribe to Featured

Health Insurance

Acupuncture: A different way to deal with pain

2Atlanta Acupuncture

In 1996, the FDA approved the acupuncture needle as a medical device.

Sara Hewitt Kupelian is not your typical medical-surgical nurse. What makes her stand out is that she is also a licensed acupuncturist.

“Learning Chinese medicine and acupuncture takes real dedication and devotion,” says Kupelian, a registered nurse for 23 years.  She estimates that she logged about 10,000 hours in class and studied for more than four years to prepare for the national certification exam.

Kupelian, who practices in Atlanta,  started her training in Georgia, but later moved to Colorado to complete her master’s degree from the Colorado School of Traditional Chinese Medicine in Denver.

She decided to study acupuncture after her mother, who later died from complications of cancer, found relief from pain and nausea through acupuncture.

“In my mother’s case,” Kupelian says, “she was able to tolerate the side effects of medications better with acupuncture. It enabled her to reduce the amount of medications needed and to offset side effects with far more relief than anticipated.”

Kupelian comes from a family of RNs, including her mother.


What’s old is new


The National Center for Complementary and Integrative Health defines acupuncture as “a technique in which practitioners stimulate specific points on the body — most often by inserting thin needles through the skin.”

Sara Hewitt Kupelian, an RN, has been practicing acupuncture for eight years.

Sara Hewitt Kupelian, an RN, has been practicing acupuncture for eight years.


According to experts in Chinese medicine, acupuncture can be traced back about 2,500 years. It has been practiced in the United States for perhaps 200 years. But not until the 1970s — when U.S. interest in China increased and Asian immigration surged — did acupuncture become widely known to the average American.

In 1996, the FDA approved the acupuncture needle as a medical device.

Outcomes of acupuncture vary, but the aim is decreased pain, as well as improved control of chronic pain.

In Georgia, the General Assembly has made acupuncture the subject of regulation and control under the Georgia Composite Medical Board. There are more than 200 licensed acupuncturists in the state.


Relief of sensory loss


“My [acupuncture] experience was a great one,” says Margretta Milburn of Sandy Springs, a recent client.

Margretta Milburn

Margretta Milburn

In her 80s, she says she was looking for something to help her with certain types of sensory loss that seemed to come with aging. She turned to Kupelian for guidance.

“I’m open to trying new things,” Milburn says. She explains that for her treatments, the small needles were placed on her head and around her ears.

It was not painful, she adds.

Milburn was able to regain some of the senses  that had slowly disappeared. Kupelian says in some cases, a loss of the senses of taste and smell can be restored using acupuncture.


Is it economical?


Some insurance companies may cover the costs of acupuncture, while others may not.

Medicare does not cover acupuncture treatments for older Americans. Some Medicare Advantage plans may offer coverage for varying types of alternative treatments, but only if they are considered medically necessary and provided by a health care professional who participates within the plan.

Mark Lewinter

Mark Lewinter

According to Atlanta licensed acupuncturist Mark Lewinter, initial consultations, which are typically about 90 minutes long, can cost approximately $100 to $200, and follow-up visits can cost from $75 to $150 and typically last about an hour.

“At Metro Acupuncture, we focus on symptoms, of course, but also preventive care and lifestyle choices, especially nutrition,” says Lewinter, who works with Dr. Anna Kelly, also a  licensed acupuncturist.

Lewinter’s interest in studying Oriental Medicine started at age 13, when he was diagnosed with cancer. While undergoing chemotherapy, he also received alternative medicine to facilitate his recovery.


Increasingly important


A 2007 survey found that U.S. adults in the previous 12 months spent an estimated $33.9 billion out of pocket on complementary health approaches, which can include massage therapy and yoga.

Ann Gill Taylor, a professor at the University of Virginia’s School of Nursing, says she finds that “practitioners who use acupuncture view the human body as an ecosystem.”

clipboardTaylor suggests that acupuncture is among the most researched and documented complementary health-enhancing practices.

“An estimated 137 plus randomized clinical trials on 10 painful conditions have been reported, which provide evidence, although not statistically conclusive, of the efficacy of acupuncture in painful conditions,” says Taylor.

Acupuncturists and other experts suggest not seeking acupuncture help without first consulting a health care professional for any pain problems.

In addition, the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) reminds all patients seeking help for pain that most states, including Georgia, require a license to practice acupuncture.

NCCAOM adds that certification, or a license, doesn’t [always] guarantee quality of care, but it does indicate the practitioner “meets certain standards regarding the knowledge and use of acupuncture.”

Kupelian says she has seen health benefits of acupuncture, including relieving acute and chronic pain among patients. She has practiced acupuncture for eight years.

“Acupuncture practice has been professionally and personally rewarding,” she says.




** If you decide to visit an acupuncturist, check his or her credentials. Most states require a license, certification, or registration to practice acupuncture; however, education and training standards and requirements for obtaining these vary from state to state. Although a license does not ensure quality of care, it does indicate that the practitioner meets certain standards regarding the knowledge and use of acupuncture. Most states require a diploma from the National Certification Commission for Acupuncture and Oriental Medicine for licensing.

** Some conventional medical practitioners — including physicians and dentists — practice acupuncture. In addition, national acupuncture organizations (which can be found through libraries or by searching the Internet) may provide referrals to acupuncturists.

** When considering practitioners, ask about their training and experience. Ask the practitioner about the estimated number of treatments needed and how much each treatment will cost.

** For information about insurance coverage for acupuncture, see NCCIH’s fact sheet Paying for Complementary Health Approaches.


Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.



Will dental ruling send ripples through health care industry?

Georgia's 9,500 nurse practitioners include Dian Evans (left), specialty coordinator for the Emergency Nurse Practitioner Program at Emory University's Nell Hodgson Woodruff School of Nursing.

Georgia’s 9,500 APRNs include Dian Evans (left), specialty coordinator for the Emergency Nurse Practitioner Program at Emory University’s Nell Hodgson Woodruff School of Nursing. Photo credit: Bryan Meltz with Emory Photo/Video

A recent U.S. Supreme Court ruling about teeth-whitening services may have long-term implications for health care professionals and their practices across the country.

The dispute involves the right of dental hygienists to perform such services in North Carolina. The Federal Trade Commission brought a major anti-competition case on the matter. The high court did not settle the case, but rejected the state dental board’s claim that its actions were immune from FTC scrutiny.

“In this case, the North Carolina dental board’s members, primarily dentists, were drawn from the very occupation they regulate. They barred non-dentists [in this specific case, dental hygienists] from offering competing teeth-whitening services to consumers,” said FTC Chairwoman Edith Ramirez in a press release.

The American Nurses Association says the dental board case may have “far-reaching implications beyond dentistry.”

In Georgia, the experts are divided on how, or if, the case could affect professional practice laws.

What doctors and nurses say

Debbie Bartlett, CEO of the Georgia Nurses Association, says her organization “will utilize the Supreme Court’s ruling to help inform Georgia legislators about the need to support federal antitrust laws [as well as] avoid unduly suppressing pro-consumer competition.”

Georgia state practice and licensure law restrict the ability of nurse practitioners — nurses trained to perform many tasks often left up to doctors — to engage in at least one element of practice. Georgia nurse practitioners, also known as advanced practice registered nurses (APRNs), cannot write prescriptions for Schedule II medications. And their ability to order specific diagnostic tests is also limited.

The state requires supervision, delegation or team management by licensed physicians in Georgia in order for any nurse practitioner to provide patient care.

Donald J. Palmisano Jr.

Donald J. Palmisano Jr.

Donald J. Palmisano Jr., executive director of the Medical Association of Georgia, sees little reason for concern about the high court ruling, because the kind of situation cited in North Carolina does not exist here.

“The North Carolina case is drastically different than the way the licensing boards work in Georgia.” says Palmisano. Here, a board’s proposed actions are reviewed by the state attorney general’s office and released for public comment, he notes.

“The ruling in North Carolina never rose to the level where the Medical Association needed to contact the Georgia Nurses Association,” Palmisano says.

“The two organizations [in Georgia] have a fairly strong relationship. I don’t foresee [a big impact from the Supreme Court ruling] here,” he adds.

Atlanta nurse practitioner Mary Perloe agrees. “I actually think nurse practitioner collaborative agreements with physicians and using evidenced-based protocols make sense,” she says.

“I also believe that the nurse practitioners should bear responsibility for their practice. As NPs gain more authority, accountability needs to follow, and physicians need to be relieved of this liability,” says Perloe.

Rebecca Wheeler, the GNA past president, suggests the ruling may be a mixed blessing for those in the nursing profession.

“I think the decision is great for APRNs, but I am a little worried about what this means in order to protect our own RN scope of practice from medical technician or nursing assistant roles,” Wheeler says. “I feel like this is a bit of a double-edged sword for nursing.

“I’m not saying it’s necessarily a bad thing [referring to the Supreme Court decision]. We probably need to be prepared to ‘give a little’ if we want APRNs to be able to practice to the full extent of their training in Georgia.”


The issue of dentistry


The American Dental Association (ADA) said it was “extremely disappointed” at the U.S. Supreme Court decision.

The group said the decision “constitutes a dramatic departure from the Supreme Court’s established law, and throws into question the regulatory, licensing and disciplinary authority of thousands of professional boards across the county.”

“The ruling creates a quandary for professional boards . . . with no explanation as to what level of ‘active supervision’ is necessary to invoke immunity for each board,” ADA stated.

The association said it is planning to work with other organizations to provide some kind of guidance in view of the Supreme Court’s decision.

But among Georgia dentists, as among physicians in general, there seems to be less alarm about the ruling. Frank J. Capaldo, the Georgia Dental Association’s executive director, says there are a number of important distinctions between the dental licensing boards in Georgia and North Carolina.

“In Georgia, members are appointed to the Board of Dentistry by the governor, but in North Carolina they are elected to the board by other licensed dentists,” Capaldo says. “This difference in and of itself shows significant state oversight in Georgia.”


Some see more opportunities


Scope of practice limitations for nurses exist alongside a shortage of health care providers in Georgia, especially in rural areas.

The consumer group Georgia Watch recently reported that the number of licensed APRNs in Georgia has reached more than 9,500. With the physician shortage in the state, which is expected to get worse, APRNs could help fill this primary care gap, the group’s report says.

NP Photo with manA total of 129 of Georgia’s 159 counties have a shortage of health care professionals. In fact, about 80 percent of Georgia’s counties contain substantial populations without a consistent source for primary care, according to the Georgia Watch report.

Georgia Watch and others continue to urge state policymakers to consider using more advanced practice nurses and physician assistants in health care shortage areas.

Many Georgia physicians, however, traditionally support the restrictions on the duties of nurse practitioners. They’re concerned about whether people who are not doctors — working on their own — have the training to safely diagnose and treat patients, refer them to specialists, admit them to hospitals and prescribe medications for them. These doctors think the NPs should continue to work under the oversight of physicians.

The right of Georgia nurse practitioners to prescribe medications didn’t come until 2006. Georgia was the 50th state to grant NPs prescribing ability.

Many health care experts say that with the influx of thousands of Georgians into the health care system under the Affordable Care Act, the time may be right for the state to review its scope of practice laws, especially in rural areas.

“There are, after all, cost realities here. We just need to be prepared,” says Wheeler, referring to NP restrictions.

“This [Supreme Court] ruling seems to open up the door for everyone, including medical technicians or nursing assistants, as much as it does for APRNs,” she says.


Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.


Narrow networks: Many upset as insurers exclude favorite providers

Dr. Sean Lynch, an Augusta family physician, says dozens of his patients have been notified that he is no longer part of United's Medicare network.

Dr. Sean Lynch (left), an Augusta family physician, says dozens of his patients have been notified that he is no longer part of United’s Medicare network.


Months after she first read it, Vera Brown of Augusta is still upset about a letter she received from her health insurer.

UnitedHealthcare wrote to notify her that it was dropping Dr. Sean Lynch, her physician, from its Medicare Advantage doctor network.

“I’ve been with Dr. Lynch for years,’’ says Brown, 67, a registered nurse. “He treats me like his mother.”

Lynch, an Augusta family physician, says dozens of his patients got similar letters. “For many reasons, it has been a disaster, for us and our patients,” says Lynch.

Brown and Lynch both say they have not received an adequate reason from United as to why the change took place.

UnitedHealthcare’s action in Georgia came after it dropped physicians in several other states from its private Medicare Advantage plans. Overall, thousands of members were affected.

The insurer tells GHN that the Georgia markets affected by the Medicare action are Atlanta, Augusta and Columbus, and that only about 10 percent of doctors in its Medicare network were dropped.

“We do regret any inconvenience to our members,” says Gregg Kunemund, regional vice president for United’s Medicare business in Georgia.

The United move is part of an accelerating trend of health insurers offering consumers more limited choices of medical providers. The resulting health plans have become known generally as “narrow networks.”

Complaints about limited choice of doctors and hospitals in health plans — in Georgia and across the nation — arose during the rollout of the Affordable Care Act exchanges a year ago.

Healthcare CostThe Washington Post recently reported that about 70 percent of health plans sold on the ACA’s marketplaces this past year had narrow or ultra-narrow networks, according to McKinsey and Co. The consulting firm defined “narrow” as excluding at least 30 percent of an area’s largest hospitals.

Narrow networks were increasingly being used before the ACA was enacted, but they’ve become more prevalent under the health reform law, the Post added.

Industry officials say the changes are partly about holding down costs, a prime consideration for consumers who are concerned about affordability (and a major goal of the ACA itself).

“We’re trying to build networks that balance quality and cost,’’ says Graham Thompson, executive director of the Georgia Association of Health Plans, an industry group.

Kim Holland, executive director of state affairs at the Blue Cross Blue Shield Association, told Politico earlier this year that “every indication that we’ve received . . . from think tanks, physicians and consumer advocacy groups, is that the most important factor for individuals purchasing coverage through the exchange is price.”


Traditional trade-off: Choice vs. cost


The interplay between access to providers and costs has existed for years in the health insurance market.

“People have to recognize it’s a trade-off, and I’m not sure they do yet,” Matt Eyles, an insurance expert at the Avalere Health consulting firm, told Politico. “Broader access comes at a cost, and what’s the right balance between access and cost is an age-old question in health care.”

UnitedHealthcare, meanwhile, disputes the characterization of its Medicare Advantage physician network in Georgia as narrow. “We feel we have an adequate network,’’ United’s Kunemund says. “We want to make sure our members get great care.”

Geography, quality and efficiency are among factors that have influenced the company’s decisions, he adds.

The decision has no impact on the retiree members of the State Health Benefit Plan who will be moving to United’s Medicare Advantage plan next year, Kunemund says.

Still, the dislocation for current patients can be jarring, says Lynch, the Augusta physician.

“Most of my patients were assigned to an 82-year-old doctor,’’ says Lynch, who is 44. “No offense to this doctor, but how does it help my patients who have been sent to an 82-year-old doctor who’s about to retire?”


Lack of transparency


It’s difficult to determine how many Georgians have been affected by narrow networks.

But problems with Georgia’s ACA exchange networks became apparent last fall, during the exchange’s first open enrollment period.

Cindy Zeldin

Cindy Zeldin

“Provider directories were inaccurate or not up to date, or people were having problems finding a provider,’’ says Cindy Zeldin of the consumer group Georgians for a Healthy Future, which has supported the ACA.

If limited networks are done right, she says, ‘they’re not necessarily harmful to consumers.” And insurers have a legitimate argument about keeping costs down, Zeldin says.

Health insurers may be looking to drop what they perceive as high-cost doctors or hospitals, or they may be trying to negotiate the paying of lower fees to medical providers, she says.

“It’s not transparent,’’ Zeldin says. “It’s hard to get a handle on how these strategies are designed.”

Patients are often left confused over who’s in and who’s out of a network, says Dr. James Barber, an orthopedic surgeon in Coffee County. “There’s a lack of transparency for consumers.”

“Eventually, narrow networks will get so narrow that patients will revolt, just like they did with the HMOs in the 1990s.”

Barber says he’s concerned that the fear of being excluded from a narrow network may force physicians to accept lower reimbursements.

Plan options will increase for 2015


The state department of insurance has been tracking the issue of how adequate the exchange health plans’ medical provider networks are.

“We’ve been getting complaints from many Georgians,’’ spokesman Glenn Allen told GHN in June. Those consumers have either lost a longtime physician or a trusted hospital by enrolling in an exchange plan, or have not found enough physicians in their network, he said.

Thompson, of the Association of Health Plans, points out that Georgians will have more choices of insurers in the ACA exchange for the upcoming year, both in metro Atlanta and other areas of the state.

Georgia’s largest physician organization, though, says narrow networks “threaten the individual and trust-based relationship that physicians have with their patients.”

Donald J. Palmisano Jr.

Donald J. Palmisano Jr.

“Narrow networks also undermine the economic viability of the medical profession, which employs a lot of Georgians and which makes a significant contribution to the state’s economy,’’ says Donald J. Palmisano Jr., executive director of the Medical Association of Georgia. He adds that the increase of these networks “will exacerbate the shortage of physicians in Georgia.”

“MAG believes that patients should have the freedom to see the physician of their choice as long as the physician is willing to participate in the patient’s health insurance network,’’ Palmisano adds.

John Crew of Strategic Healthcare Partners, which consults for more than 30 hospitals, 600 physicians, and 26 behavioral health centers in Georgia, says he fears that all insurance companies are using this tactic to drive down reimbursement to medical providers.

He says narrow networks may favor those physicians who are employed by hospital systems. They also could exclude rural physicians, Crew says.

Zeldin, meanwhile, says that consumers should shop around as they review health plans, and ask for up-to-date provider directories from insurers.

Meanwhile, in Augusta, Vera Brown is changing her Medicare coverage so that she can keep Dr. Lynch as her physician.

“I’m going to stay with Dr. Lynch, whatever plan I go on,’’ Brown says. “When you get older, you don’t want to do all this flip-flopping. It’s not good for older folks.”

Small firms’ exchange has a big problem: It’s off to a very slow start

The owners of this antiques and home decor business aren't interested in the small business insurance exchange.

The owners of this Braselton antiques and home decor business say they aren’t interested in the small business insurance exchange.

The health insurance marketplace for small businesses is now open.

But Mom and Pop aren’t buying.

Many small employers do not even appear interested in checking out this feature of the Affordable Care Act, which is different from the better-known individual exchange where people buy coverage for themselves.

Jackie Stowe is a small business owner trying to settle into a new location.  She and her husband, Mike, recently moved their antiques and home decor store from Hoschton to Braselton.

Stowe plans to add a couple more people to the JarFly Station payroll, but she’s been so busy with the move that she admits health insurance hasn’t been on her agenda.

Meanwhile, everyone in the store’s small workforce already has insurance. Mike is also employed with Keller-Williams Realty, and he and his wife are covered through that company. And the couple’s two employees get health insurance through their spouses.

Stowe says she needs to do more research, but she hopes that she does not have to get a plan through the Small Business Health Options Program (SHOP), the government’s health insurance marketplace for small businesses.

“I don’t really want to go through it,” she said.

And she’s not alone.

An option, not a mandate


“I think it’s become so complicated that the reaction for people is just to shut down,” said Ann Murray, head of the employee benefits practice at the law firm McKenna Long and Aldridge.

Unlike with some other programs of the ACA, this is an option, not a mandate. The health law does not require businesses with fewer than 50 employees to offer health insurance to their workers.

But SHOP is meant to help small business owners find affordable coverage. As incentives, the government offers certain tax credits and deductions to employers with fewer than 25 employees who set up coverage through SHOP and help pay for it.

Currently in Georgia, the only way to sign up for a SHOP plan is to go see an agent, broker or insurance company and fill out the paperwork.

Interested employers can view SHOP plans and prices through an online premium estimation tool.  However, to enroll in SHOP coverage, employers need to enroll directly with insurance companies and pay them the first month’s premium.

Online enrollment won’t be available till later this year.

To get the tax credit, employers need to submit an application to determine their SHOP eligibility. Interested employers can download the application online and send it by mail; apply by phone; or work with an agent, broker or insurance company.

‘Not our most popular offering’


While some companies enroll in the small business exchange because of the tax breaks, some employers prefer to skip SHOP’s “intensive” paperwork and just advise workers to seek their own coverage through the individual exchange, said Bert Kelly, director of communications for Blue Cross and Blue Shield of Georgia,

Blue Cross is one of the companies that offer SHOP plans in Georgia, but Kelly said, “It’s not our most popular offering.”

The goal of SHOP is to provide a variety of health insurance options to both employers and employees of small businesses.

Under the original ACA design, workers from different small businesses could enter the SHOP exchange and be able to pick a health plan from several options, similar to what large employers offer.

But currently in states that have federally run insurance exchanges, such as Georgia, only employers can choose the plan they will provide. Employees will not be able to choose their plans until late 2015 or even 2016.

On top of delayed and only partial implementation, eligibility requirements are complex.

“A lot of the people are confused,” said F.J. Fenn, president of the Jackson County Area Chamber of Commerce.

The Jackson Area Chamber of Commerce say local businesses are confused about the SHOP option.

The Jackson County Area Chamber of Commerce says local businesses are confused about their ACA options.

Fenn says the law’s new policies could have been introduced and explained a lot better. He encourages business owners to talk to their current insurance provider to make sure they really understand how the law is going to affect them as individuals and as business owners.

But mom-and-pop owners have little time to wrestle with new rules about health insurance because they’re juggling payrolls, books and inventories, legal expert Murray said.

Enrollment barriers and launch delays for the online exchange have discouraged a lot of people, she said.

In February, to help with the transition to the ACA’s requirements, the Obama administration delayed the mandate for employers that have to provide insurance to full-time employees. Businesses with 100 or more employees will not be fined for failing to provide health coverage till 2015, and businesses with 50 to 99 employees will not face fines until 2016.


Larger paychecks rather than benefits


Meanwhile, many Jackson County business owners are not even thinking about providing health insurance for their workers, much less using the government marketplace as a way to do it. Some of these owners have very small businesses and don’t employ anyone but themselves, while some hire people who already have coverage through parents or spouses.

Shawn Watson, owner of Legacy Landscape Management in Jefferson, has given the matter some thought. And he says that his employees would rather have larger paychecks than benefits.

“In the past, most employees were not interested in insurance,” he said in an email.

Watson has personal health insurance coverage, and said he knows that six of his eight employees are covered either through their spouses or through an individual health plan. He does not know about the other two.

According to an analysis done by the Kaiser Family Foundation, workers at businesses with fewer than 50 employees are 25 percent of the workforce, but they account for 40 percent of all uninsured workers.

Ultimately, suggests Murray, what happens with small business health insurance will be up to individual workers, not employers. The business owners will have to worry about providing such coverage only when – and if – their workers start calling for it.

But uninsured workers will probably not take that step until they face their other options under the ACA: either to buy insurance themselves or pay a penalty.

“Until it hurts the individual, [they’re] not going to start complaining” about small businesses’ lack of coverage, she said.

Hyacinth Empinado is a freelance science writer. She is currently a first-year graduate student in the health and medical journalism program at the University of Georgia.


Faithful recruiters: Two from Catholic order joined ACA effort

Cecelia Smaha (seated) and Sr. Joan Serda at a Get Covered America event in Atlanta

Cecelia Smaha (seated) and Sr. Joan Serda at a Get Covered America event in Atlanta

The volunteer army in the Affordable Care Act enrollment effort included two older women stationed regularly at a Macon Kmart.

Sister Joan Serda and Cecelia Smaha, a layperson associate of the Sisters of Mercy, talked to hundreds of local residents about the health care law in the months leading up to Monday’s enrollment deadline.

The two say they volunteered for the Get Covered America campaign because their organization’s mission includes helping people living in poverty who lack education and health care.

“I feel terrible that so many people don’t get health care,’’ said Serda, 76, who has been a nun since 1956. She’s a retired educator, so the role of informing people about their insurance choices was a natural fit.

She and Smaha set up a table at Kmart, answering questions about the ACA and talking about coverage, and gathering names of people who wanted further help. They also did education sessions at local Catholic parishes.

James Ramirez, the Get Covered America official who oversees Macon, says Serda and Smaha made a huge impact in the education effort.

“They are probably the most passionate, dedicated people I have seen in my experience, willing to sacrifice their time and energy to make the world a better place,’’ he says. “There is no way we could have made this much impact in Macon without their help.”

Hours after the midnight Monday deadline for sign-ups, the White House announced Tuesday that more than 7 million Americans were enrolled in the health insurance exchanges.

The two Macon women didn’t help people sign up directly. They were not “navigators,’’ specially trained counselors hired to help people enroll in the insurance exchange.


Divisions among Catholics

Still, they say, there was a lot of education to be done about the complicated law, which has many critics and is not well understood by many Americans. The state’s Republican political leadership remains united against the Affordable Care Act, also known as Obamacare.

Sr. Joan Serda at Kmart in Macon

Sr. Joan Serda at Kmart in Macon

The hardest thing to explain to opponents of the law was that the ACA helped the working poor, Smaha says.

“This is not a freebie,’’ says Smaha, 71, who has been a lay associate of the religious order since 2000. “Some people [signing up] had two or three part-time jobs.’’

None of the ACA opponents who talked to them were “really rude,’’ Serda says.

“We had a few people who came to us and discussed their opinions,’’ she adds. The two say they acknowledged to the skeptics that the ACA isn’t perfect, that it could be improved. “No one was ugly’’ in the way they disagreed, Serda says.

Some of the law’s provisions have been opposed by the U.S. Conference of Catholic Bishops. The group set out a position that supported the expanding of insurance coverage to millions of Americans. But the bishops also opposed final passage of the ACA because of concern that it would expand the role of the federal government in funding and facilitating abortion and plans that cover abortion.

The bishops also oppose the ACA requirement to offer insurance coverage for contraceptives. A Catholic religious order, the Little Sisters of the Poor, has fought in court against a contraception coverage mandate for people it employs.

A spokeswoman for the bishops noted Wednesday that while they have opposed certain provisions of the ACA, they have not joined in efforts to repeal the law.

Serda and Smaha do not appear overly concerned about these stands by the bishops and some other Catholics. Their order, the Sisters of Mercy, on their website said they supported the passage of the ACA out of a conviction that people have a right to health care.


Two outspoken women

Serda and Smaha say their biggest challenge was not having a navigator at Kmart to help people apply for coverage. Kmart didn’t allow it, they say. “We would have gotten a lot more people,’’ Serda says.

A spokeswoman for the company said in an email to GHN that the role of the insurance navigator is to help consumers prepare electronic and paper applications and enroll in coverage.

“This may have been why the navigator was not able to assist,’’ the spokeswoman said. “No computers were on site nor were any enrollments being processed.’’

The two women say they’re unhappy with the decision by Gov. Nathan Deal not to expand Georgia’s Medicaid program. Expansion of Medicaid is outlined under the ACA but is optional for states, and several are not doing it. Deal, backed by fellow Republicans who control the General Assembly, says Georgia can’t afford to do it.

If Medicaid expansion were carried out, it would extend coverage to hundreds of thousands of uninsured Georgians, who are making below 100 percent of the federal poverty level but don’t qualify for subsidies in the insurance exchange.

“So many people have been caught in the gap,’’ with neither Medicaid nor subsidies, Smaha says.

The two women don’t know how many of the people they talked to eventually enrolled in coverage.

“I think it was worthwhile because we helped some people,’’ Serda says.

Ramirez of Get Covered America has a stronger view. He says Serda and Smaha “have been central to our success statewide, but definitely in Macon.”


  • Sign up for our mailing list.