South behind other regions in health, report says

Southerners have high rates of chronic disease such as diabetes and are more likely to be uninsured than people in other regions, a newly released report says.

And nearly one-quarter of Southerners report they do not have a usual source of health care. That’s significantly higher than for adults in the Midwest and Northeast, though it’s similar to the rate for residents in the West.


The Kaiser Foundation “issue brief” was prepared for a March meeting of health care stakeholders from the South and around the nation, held at the Satcher Health Leadership Institute at the Morehouse School of Medicine in Atlanta. It was released publicly last week.

The report defines the South as a fairly broad region, and includes Oklahoma, Delaware, West Virginia and Maryland as among the 16 states plus the District of Columbia.

The South has a rapidly growing population and is more racially and ethnically diverse than other regions, the report notes. People of color make up 41 percent of the total Southern population.

The South also includes states with high poverty rates. Georgia, at 24 percent, is among the states higher than the national average of 21 percent.

The majority of the uninsured in the South live in Texas, Florida and Georgia, according to the report. The uninsured in these three states, in fact, account for 44 percent of the uninsured nationwide. Yet as of 2012, the three have the lowest number of federally qualified health centers per 1 million low-income residents.

(Texas, Florida and Georgia are among the nation’s most populous states, ranking No. 2, No. 4 and No. 8, respectively, according to current estimates.)

People of color make up the majority of uninsured in the South, while 42 percent are white.


Meanwhile, the South contains states with the highest rates of diabetes, heart disease deaths, infant mortality and cancer deaths.

“More than anything, [the report] reconfirmed to me the unique challenges in the South,’’ said Dr. Harry Heiman, director of health policy at the Satcher Health Leadership Institute. Heiman cited the health disparities and burden of chronic diseases in the region, such as heart disease, hypertension and diabetes.

The Kaiser report also notes that most Southern states are not expanding Medicaid under the Affordable Care Act.

Georgia’s Republican political leadership has opted against expansion, citing the cost to the state. And the General Assembly passed a bill to require legislative approval for Medicaid expansion (making it harder to enact in the future), and another that ends the ACA-funded health navigator program at the University of Georgia.

By states rejecting the Medicaid option, many poor uninsured residents will not gain coverage, the report notes. Nearly 4 million poor uninsured Southerners – including 409,000 Georgians – fall into a coverage gap because they will remain ineligible for Medicaid but don’t earn enough to qualify for the subsidies in the health insurance exchange, also part of the ACA.

Dr Harry Heiman
Dr. Harry Heiman

If all states expanded Medicaid, Southern states would experience the large percentage increases in federal funds compared with states in other regions, the report said.

And medical providers will miss out on additional Medicaid reimbursements.

“If all states expanded Medicaid, Southern states could also experience a 25 percent increase in Medicaid payments to hospitals relative to no expansion — the highest percentage increase of any region,” the Kaiser report said.

Heiman called the states’ rejection of Medicaid expansion “baffling.”

“It’s the juxtaposition of the significant disease burden and significant disparities in the South against this incredible opportunity to leverage federal dollars to address these problems,’’ he told GHN.

One in five Georgians live in a primary care health professional shortage area, slightly lower than the region’s average of 22 percent.

Recently, Gov. Nathan Deal signed a bill that will expand a scholarship program to place medical students in areas where they are most needed to practice medicine. Another bill gives community physicians a tax credit for overseeing students in medical school, and in physician assistant or nurse practitioner schools.

Yet other state policies don’t help increase access to care in underserved areas, the report said. Eleven states, including Georgia, restrict the scope of practice for nurse practitioners, preventing them from practicing independently.