Georgia's policies and lack of Medicaid expansion contribute to worsening health outcomes

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The 2021 Commonwealth Fund scorecard evaluates health equity across race and ethnicity, both within and between states, to illuminate how state health systems perform for Black, white, Latinx/Hispanic, AIAN, and Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations.

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No state in the nation is exempt from a burden of illness that stems from lack of access to care, poor quality of available care and preventable mortality, but the disparities in Georgia are more pronounced, according to the latest scorecard from the Commonwealth Fund. 

Part of the reason is that Georgia is one of a dozen states that did not expand Medicaid. 

Health insurance is the gateway to the health care system, Commonwealth Fund president David Blumenthal said, calling insurance "necessary, but not sufficient, to remedy disparities in care in and inequities in care.” 

The Scorecard on State Health System Performance has long tracked the functioning of each state’s health care system, with the goal of motivating policymakers’ actions to improve their residents’ health and health care. 

Medicaid, as it has been implemented under the Affordable Care Act, offers enormous help to uninsured people, who are disproportionately people of color in the United States, to gain access to a health care system that offers lifesaving care and lifesaving medications, he said. 

So, while white Georgians are in the lower half of the distribution, people of color are “stuck in the water,” Blumenthal said. 

“Their lives and their environments are affected by histories of racial prejudice,” Blumenthal said. “For example, redlining, residential segregation, underfunding of their schools and systematic incarceration.” 

For years, Black Georgians have been more likely to die of breast cancer, due in part to late-stage diagnoses — which can also be attributed to higher numbers of uninsured people. 

Georgia also ranks at the bottom for maternal mortality and access to mental health care. 

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The Commonwealth Fund hopes policymakers and health system leaders will use the scorecard to investigate the impact of past policies on health across racial and ethnic groups, and that they will begin to take steps to ensure an equitable, antiracist health care system for the future. 

In states that expand Medicaid, the health of the population, especially of people of color, improves, Blumenthal said. That includes improvements to their perceived well-being, access to care and overall health.  

By not expanding Medicaid, states are foregoing the possibility of improving the health of the uncovered populations, Blumenthal said.  

“It's a conscious decision 12 states have decided to make,” he said. “That decision amounts to nothing short of a death sentence for hundreds of thousands of people within (Georgia’s) borders.”