Health Insurance

“The Weight of The Nation," an HBO documentary series, takes a hard look at the obesity epidemic in the U.S.

Vivia Armstrong responded to an ad about obesity a couple of years ago.

At the time, Armstrong, living in southwest Atlanta, knew all about weight problems. Being heavy is the only kind of life she has ever known.

She described her struggle to GHN in an interview before the Atlanta premiere of “The Weight of the Nation,’’ an HBO documentary about obesity in which she appears.

“I’ve never been thin,’’ Armstrong said. “I take out a lot of my stress through eating.’’

Growing up in Chicago, Armstrong, now 28, lost her father when she was 10. Her mother worked occasional odd jobs as a single mom, and fast food became a standard meal. The neighborhood wasn’t a good place to exercise.

Armstrong’s weight rose to the 300-pound range. She has had high blood pressure since she was 11.

Physical education classes at school were ‘‘humiliation hour,’’ she said. “I was seen as the fat girl.’’ She hated going to the doctor.

Every decision she made — about travel, work, etc. — had to take her weight into account.

When the ad led to an interview before HBO’s cameras, Armstrong said, she wanted above all to be honest about her condition.

Honesty is a central feature of “The Weight of The Nation.’’ The documentary series, debuting Monday on the cable network, takes a hard look at the obesity epidemic in the U.S., exploring causes, effects and possible solutions.

Jarring facts

More than two-thirds of adults in the United States are overweight or obese –- a trend that has increased since the 1980s. It’s an expensive condition: Obesity-related health care costs reach $150 billion annually.

And the obesity rates may grow even higher. Even now, Georgia has the second-highest rate of childhood obesity among the states. Regionally speaking, obesity rates are highest in the Southeast.

It hits low-income and minority neighborhoods the hardest, those where fast-food restaurants proliferate, large grocery stores are scarce, the streets are often dangerous, and there are no parks or playgrounds.

“Obesity is a costly, serious and widespread problem,’’ Dr. Thomas Frieden, the CDC director, told a Carter Center audience before the Thursday screening of Part 4 of the documentary series. But he also said there are ‘‘real glimmers of hope’’ — programs that work.

“The Weight of the Nation’’ is a collaboration among HBO, the Institute of Medicine, the CDC, the National Institutes of Health, along with Kaiser Permanente and the Michael and Susan Dell Foundation.

An executive producer of the series, John Hoffman of HBO, said before the screening that it represented a unique partnership on a public health campaign.

“The public health community came to us’’ to explore obesity, he said.

The film makes strong use of statistics, such as the fact that less than 3 percent of the nation’s farmland is growing fruits and vegetables. And while soft drinks have a 90 percent profit margin, fruits and vegetables have a 10 percent margin.

“Diabetes follows obesity as night follows day,’’ Frieden says in the film.

But the HBO series also tells encouraging stories –- of an Arkansas company creating a wellness program, a Nashville mayor pushing anti-obesity campaign.

And then there are subjects such as Vivia Armstrong, “We treat them with great honor and respect,’’ Hoffman said.

Dr. Christopher Griffith, a psychiatrist with Kaiser Permanente of Georgia, said the film ‘’sends a wake-up call.’’

“Obesity robs people of hope and ambition,’’ Griffith said. “It leads to depression, to diminished self-esteem.’’

Solutions presented in Part 4 of the documentary include instituting new employer exercise and wellness programs; providing better food choices in schools; walking programs for children and adults; adding parkland and sidewalks; bringing fresh fruits and vegetables to fast-food-dominated neighborhoods.

Less judgment, more action

Armstrong said she didn’t really know what to expect when she responded to the ad. “They were looking for people who were obese or had been obese,’’ she said to GHN. It was only when she was called in to be interviewed that she found out HBO was involved.

How did seeing herself in the documentary make her feel?

“When I first saw myelf, I laughed. The next part of the film, I cried.’’

“It was me being so extremely vulnerable,’’ she said. “It’s hard to watch.’’

But she also said, “I was hoping it would help somebody, a young child.’’

Armstrong has had to learn how to cook and exercise. “You still need to learn that you need to eat to live, not live to eat. When you get older, it gets harder.’’

Those without weight problems should ‘‘not be so quick to judge,’’ she said. Part of the problem with some people is genetic.

She said she has tried different diets, foods and programs, some of which have been too expensive. She normally works as a marketer but is between jobs right now.

Armstrong recently got health insurance through the health reform law provision that established ‘‘high-risk’’ pools for people with pre-existing conditions. “I was denied plenty of times’’ by health insurers, she said.

She then found out she was allergic to several foods, including tomatoes and oranges.

Since the filming, she has been exercising, mostly doing water aerobics. “It works for me,’’ she said. She has lost 20 pounds.

She said she still needs to do more planning when it comes to meals. But she believes being consistent with exercise is the key.

Hoffman says Armstrong shows the emotional side of coping with obesity. “She opens up in a very profound way,’’ he told the audience after the screening. Americans have not heard enough from people who struggle with their weight, he said.

Armstrong told the audience, “It’s an ongoing struggle, but it’s possible, it’s achievable.’’

The documentary series will be available online at HBO.com, and thousands of screening kits are available to community and school organizations as well. Here’s a link to the trailer.

After Joe Sellers was diagnosed with leukemia, he was able to get decent health insurance for his wife and children, but not for himself.

Joe Sellers sees himself as a square peg fitting into a round hole of health insurance.

A real estate agent in the northern Atlanta suburbs, Sellers was diagnosed with leukemia in 2009. The next year, his health insurance company said it was going bankrupt, and he lost that policy.

So Sellers, middle-aged and self-employed, had to scramble.

He was able to buy an adequate plan for his wife and children. But with his pre-existing condition, he was basically uninsurable. All he could get for himself was a barebones policy, called ‘‘limited benefit.’’ (Here’s a USA Today article about these plans.)

Sellers went looking for what he calls ‘‘a regular job, so I could get group coverage.’’ But in a very difficult economy, there were few opportunities.

Later, he looked into the government’s Pre-Existing Condition Insurance Plan, designed for people, like himself, with health problems. But Sellers had insurance — albeit threadbare –- and thus was told he did not qualify. PCIP requires a person to be uninsured for at least six months to be eligible for enrollment.

Enrollment, and costs, picking up

PCIP, launched under the 2010 health reform law, got off to a very slow start in Georgia and elsewhere.

But last week, the federal government announced that nearly 50,000 Americans have now enrolled in  PCIP. And the number of Georgians in the state’s ‘‘high-risk’’ pool for people with pre-existing health conditions has nearly tripled in less than a year, to 1,476.

As of March 31, 2011, Georgia had just 515.

Georgia’s current number in PCIP is similar to enrollment in other states’ high-risk plans that were set up prior to the health care reform law, says Bill Custer, a health insurance expert at Georgia State University.

Reasons for the increase in enrollment include the feds’ lowering the monthly premiums for  PCIP in Georgia and showing more flexibility on how a person demonstrates a pre-existing condition, says Cindy Zeldin, executive director of the consumer advocacy group Georgians for a Healthy Future.

Another factor, she says, is more publicity about PCIP. ‘‘The word has gotten out a little more,’’ she says.

Twenty-seven states are operating their own PCIP program, often linked with existing ‘‘high-risk’’ insurance pools. Georgia, 22 other states and the District of Columbia have federally operated program.

Many of the enrollees are 45 years of age and older, but still are not old enough to be eligible for Medicare.

And many, like Sellers, now 46, have cancer.

In covering such serious medical conditions, PCIP’s health care costs for enrollees are expected to be more than double the amounts initially predicted for the program, the Washington Post reported.

Some don’t have time to wait

PCIP’s coverage would be a definite upgrade from Sellers’ current policy, which would pay just $30,000 for a hospital stay and $5,000 for an injury.

He does not have the practical option of dropping his current policy and then waiting six months. His doctor told him in December that he needed to start treatment immediately, Sellers says.

The six-month waiting period is a barrier for people such as Sellers, notes Custer.

The health reform law, which will be fully implemented in 2014 unless derailed by the Supreme Court or Congress, would resolve Sellers’ problem by allowing him to enter an insurance exchange.

‘‘The law is intended to prevent situations like his,’’ Custer says.

Sellers, a Republican who lives in Kennesaw, says he’s not exactly enamored of the health care law, known officially as the Affordable Care Act. He sees it as too rigid. But he says government should be able to help ‘‘square pegs’’ such as himself.

“When a person has exhausted all other means, our government should step up and take care of those people who can’t take care of themselves.’’

He recently received a big break when a drug company agreed to give him a chemotherapy drug free of charge. Normally it would have cost $30,000 over six months, he says. “It was a gift from God,’’ he says. Sellers adds that family and friends have offered to help, too.

But he worries about the possibility of getting an infection and being hospitalized –- and the resulting out-of-pocket costs.

PCIP is ‘‘a great idea,’’ Sellers says, but it needs to be more flexible. “This is not a Republican or a Democrat thing,’’ he says. “I’m the guy with cancer in the middle.’’

The Georgia Legislature passed a bill to create a separate state agency for public health.

Here is GHN’s list of the Top 10 Georgia health care stories of 2011:

1. Atlanta federal appeals court rules on health reform

The 11th U.S. Circuit Court of Appeals struck down the law’s requirement for individuals to buy insurance, though it upheld the rest of the law. This decision virtually assured that the U.S. Supreme Court would have to rule on the Affordable Care Act, and the high court has since agreed to do so in 2012.

2. New public health agency

The Georgia Department of Public Health was created by the Legislature and opened in July under Commissioner Brenda Fitzgerald, and a board was appointed.

3. The Albany hospital acquisition

The local hospital authority withstood fierce legal opposition by the Federal Trade Commission and won the right to purchase Palmyra Medical Center from HCA, cementing control over the hospital market in the city.

4. The Tea Party defeats Deal’s health exchange bill

The legislation that would have set up the mechanism for a state health insurance exchange died amid unexpected opposition from Tea Party members. Gov. Nathan Deal then appointed an advisory panel that recommended proceeding with the idea for small businesses.

5. Consolidation among hospitals

Besides the Albany merger, other acquisitions and partnerships occurred in Valdosta, Greensboro, Fort Valley, and in metro Atlanta, driven by partnerships between Emory and St. Joseph’s and Piedmont and Henry Medical.

6. Assisted living bill passes Legislature

The legislation — designed to help residents of assisted living facilities remain in place and not be forced to enter nursing homes — had been sought for a long time.

7. Grady, Fresenius reach dialysis deal

The saga of immigrant health care heated up before Grady Memorial Hospital and Fresenius Medical Care reached an agreement on providing dialysis services for 21 patients whose regular treatment had ended a week before.

8. Albany fax case reaches Supreme Court

It started as a local feud, with anonymous faxes ridiculing Phoebe Putney Memorial Hospital. But it could wind up setting a legal precedent for criminal investigations nationwide. The justices will decide whether prosecutorial investigators have total immunity from being sued for giving false testimony before a grand jury.

9. WellStar vs. Northside

The two powerful hospital systems, vying for patients, waged a protracted fight in the state regulatory system over licenses for facilities in the Atlanta suburbs.

10. Georgia gets break on insurance requirement

The federal government, at the state’s request, gave Georgia health insurers permission to gradually meet new restrictions on how they spend premium dollars under the health care reform law.

What do you think of this list? Post a comment or send an email to amiller@georgiahealthnews.com

Dr. Charles Johnson meets with uninsured patient Caron Anderson at the Good Shepherd Clinic in Morrow.

The clinic’s waiting room filled up quickly Wednesday morning, and there were still more patients waiting outside, sitting on the porch of the converted home.

Good Shepherd Clinic, which provides free medical services to the uninsured of Clayton County, is a busy place every Monday and Wednesday, the only days when it’s open.

Patients and staff squeeze past each other in the narrow hallways, and there’s a steady flow of people in and out of the exam rooms.

The Morrow clinic draws people such as Lois Joiner, 63, of Forest Park. Joiner is unemployed and hasn’t had health insurance in five years. She has high blood pressure and high cholesterol, and has a regular appointment at Good Shepherd every three months.

When asked where she would be without the clinic, Joiner promptly answered: “The emergency room.’’

The day after the U.S. Census Bureau reported that nearly 50 million Americans had no health insurance in 2010 – a record high – Good Shepherd staff and patients said they weren’t surprised that the number is increasing.

“Nobody is working,’’ said Gary Shelton, 49, of Forest Park, who has diabetes and high cholesterol. He’s a refinisher of hardwood floors, but he hasn’t gotten many jobs in the past few years.

“There’s hardly any way to pay’’ for care, he said as his blood pressure was being taken.

Good Shepherd, like other free and charitable clinics in the state, is seeing greater demand for services.

Unemployment in Clayton County, just south of Atlanta, hovers at 13 percent, higher than the state and metro Atlanta rates. About 20 percent of county residents have no health insurance, roughly the state average.

Georgia’s uninsured rate ranked sixth among states in a three-year average in the Census report.

Many patients at Good Shepherd are the working poor, who either are not able to afford insurance or are not offered such coverage by their employers, said Jim Phillips, a former Delta Air Lines employee who’s chairman of the board of the clinic. “We have about a four-month waiting list.’’

Faith and generosity keep effort going

Georgia has 96 free and charitable clinics, the highest total of any state, said Donna Looper, executive director of the Georgia Free Clinic Network.

Much of the spread of these clinics in Georgia comes thanks to churches and other faith-based organizations, she said, with about 70 percent of the clinics having such affiliations.

“They’ve stepped up to the plate and filled the void in their communities,’’ Looper said of the religious groups.

The state’s clinics served 320,000 patients last year, and the persistent economic slump keeps pushing demand higher. Waiting lists for appointments run from six weeks to six months, Looper said. “Some clinics can’t even keep up with a waiting list.’’

The patients generally have chronic disease such as diabetes and hypertension, and part of Good Shepherd’s $280,000 annual budget goes to purchase medications. The clinic also gets drug samples and links patients to free medication programs run by pharmaceutical manufacturers.

Individual donations supply much of the money that the clinics run on.

The medical care is donated, too. One of the volunteers at Good Shepherd is Dr. Charles Johnson.

A primary care physician for more than 50 years, Johnson, in his 80s, joked that the volunteer work “keeps me off the streets.’’

“I love the practice of medicine,’’ he said. But he added that he can’t see all the patients who need help. “We don’t have enough physicians,’’ Johnson said.

Another volunteer is medical assistant Elaine Saperstein, who along with her husband, Jay, is unemployed. Her husband has diabetes, she said. “If it wasn’t for this place, my husband couldn’t get his medications, his insulin,’’ she said.

‘A never-ending battle’

But even this valuable safety net has some large holes.

If a Good Shepherd patient needs to see a physician specialist, it’s very difficult to get a referral, said Lisa Page, the clinic administrator. She told the story of a patient with leukemia whom the clinic finally had to send to a hospital emergency room, along with his medical paperwork.

Orthopedists are hard to find to set a broken bone, Page said.

Good Shepherd is open just a few hours a week. It would need to be open 40 hours-plus to meet the demand, Page said.

“It’s a never-ending battle,’’ she said, adding that the clinic is trying to hire a part-time nurse practitioner.

The patients are grateful to be there. “I don’t have the out-of-pocket money to pay for doctor visits and prescriptions,’’ said Hazel Moore, 62.

And Caron Anderson, 59, had a stark answer when she was asked what would happen if she didn’t have access to Good Shepherd. “Without it, I’d just be suffering,’’ she said.

Woodstock — Mark Hudgins arrived at 5 a.m. Saturday and in ‘’a lot of pain.’’

Mark Hudgins

Hudgins, 53, a construction worker from Canton, has been unemployed for several years, and has no insurance. The pain had been going on for a long time, he said, and then pointed to one of his upper teeth.

He was among more than 2,000 people treated at a two-day free dental clinic, run by volunteer dentists and other health professionals, at the First Baptist Church of Woodstock.

Many of the clinic patients, like Hudgins, are unemployed. And many have postponed dental visits for years.

“There ain’t nothing like a bad tooth,’’ Hudgins said, sitting in a line of people awaiting an extraction.  He was encouraged that afterward, ‘’this pain will be gone for good.’’

The mass of people coming Friday and Saturday to the clinic took some dental professionals by surprise.

“It’s overwhelming,’’ said Dr. Paul Kudyba, a Sugar Hill prosthodonist who was serving people with full and partial dentures. “We cannot come close to meeting demand. These technicians are maxed out.’’

More than 300 dentists and hundreds of other health professionals volunteered for the event. Patients received cleanings, fillings, extractions, dentures and root canals, along with information about dental health.

The event, called Georgia Mission of Mercy, followed similar clinics in 17 other states.

‘No dental safety net’

Joanna Richards of Cartersville received a full upper denture and a partial lower one. She, too, arrived at 5 a.m. Saturday, and said it was ‘’worth the wait.’’ It had been ‘’some years’’ since her previous dental visit, Richards said.

While roughly 20 percent of  Georgians have no health insurance, a much higher percentage lack dental coverage.  Even in the best of economic times, only about half have dental insurance, according to the Georgia Dental Association.

“We know there is no dental safety net for adults in this state,’’ said Martha Phillips, executive director of the Dental Association, which sponsored the free clinic. One constant theme among the clinic patients is that ‘’people have lost jobs,’’ Phillips said.

Phillips said church groups brought homeless people from Atlanta to the dental clinic, as well as women from a domestic violence shelter.

Added Doug Torbush, a Conyers dentist:  “We have some who have never been to the dentist. And it shows.’’

After going through triage for dental and medical problems, patients were ushered to a large downstairs room where dentists and assistants kept a steady flow into 100 dental chairs, with distinct areas for cleanings, extractions, root canals and fillings.

June Carpenter of Woodstock, waiting for a cleaning, said she felt ‘’like I’m one of the lucky ones,’’ not needing major work. She has been unemployed for three years.

Carpenter arrived at 10 a.m. Friday, finding out she was too late to get seen that day. So, she said, “I got here about 4:30 this morning.’’

Jerard Stokes of Atlanta said he slept in his car overnight. He was in line for a root canal.

Waiting in the chapel

Scores of businesses, foundations and individuals donated supplies, equipment, money and volunteer time.

Patients not able to be seen and those needing more dental work were referred to community clinics.

By noon Saturday, a number of people waited in the main chapel as a group called the  ‘’maybes.’’ That is, maybe there would be time to see them.

One was Danny Allen, 32, of Waleska, who works at a Goodwill. He has been in pain for two weeks, he said  “I couldn’t sleep last night,’’ he said, pointing at his mouth.

Allen then got a hopeful sign, and joined a row of would-be patients heading toward the treatment area.

By the end of the day, all the chapel ‘’maybes’’ were able to get treatment.