by Georgia Center for Opportunity | Jul 16, 2014
This is the third entry in a series of posts highlighting GCO’s new report – Increasing Access to Quality Healthcare for Low-Income Uninsured Georgians. The first entry provided an overview of the report and the second entry looked at Georgia’s healthcare safety net.
The lack of access to affordable care contributes to many individuals going without important services. Uninsured individuals in Georgia are nearly four times less likely than the insured to have had a routine check-up in the past two years[i] and are more likely to experience avoidable hospitalizations for conditions such as pneumonia, diabetes, and asthma.[ii] In 2011, 36 percent of low-income adults in Georgia reported that they went without care because of cost in the past year. Only two states had a higher percentage of individuals going without care.[iii]
Uninsured individuals are financially costly for taxpayers and the insured as well. In 2013, uninsured individuals across the country spent an estimated $25.8 billion out-of-pocket on medical care and received between $74.9 billion and $84.9 billion in uncompensated care. About 60 percent of the uncompensated care spending was provided by hospitals, 26.4 percent by publicly supported community providers, and 14 percent by office-based physicians who provided in-kind services or charity care.[iv]
Providers also attempt to recover their losses from providing uncompensated care to uninsured patients and those covered by government programs that pay below cost, such as Medicare and Medicaid, by increasing charges for those with private insurance. The higher prices charged to private insurance are passed on to families and business through higher premiums.
Estimates vary on how much cost shifting occurs. One study estimates that cost shifting through increased premiums and other similar strategies accounts for about 2.4 percent of private health insurance costs,[v] while another study estimates that uncompensated care cost shifting makes up 7.7 percent of private insurance costs.[vi] If the higher estimates are accurate, the uninsured population is costing the average Georgia individual $330 and the average family $900 per year in higher premiums.[vii]
[i] Patricia Ketsche et al., The Uninsured in Georgia, Georgia Health Policy Center, Issue Brief, November 2008, https://www.issuelab.org/resource/uninsured_in_georgia_2008.
[ii] John O’Looney, Louis Kudon, interand Glenn M. Landers, Avoidable Hospitalizations in Georgia: An Analysis of the Potential for Strategic Action, Georgia Health Policy Center, January 2005, https://ghpc.gsu.edu/sites/default/files/documents/ghpc/community_public_health/Avoidable_Hospitalizations_11-29-07_FINAL.pdf.
[iv] Teresa A. Coughlin et al., “An Estimated $84.9 Billion In Uncompensated Care Was Provided In 2013; ACA Payment Cuts Could Challenge Providers,” Health Affairs 33 (2014): 810, https://content.healthaffairs.org/content/33/5/807.abstract?=right.
[v] Coughlin et al., “An Estimated $84.9 Billion In Uncompensated Care,” 812.
by Georgia Center for Opportunity | Jul 11, 2014
Recently, the Breakthrough Fellows at GCO watched and discussed M. Night Shyamalan’s The Village. This movie, for those who haven’t seen it, chronicles a religious, cult-like community that lives deep in the woods. This community is watched by “those we don’t speak of,” who have a standing agreement to not enter into the community so long as the border outside of the community’s village is not breached.
As the movie progresses, the social fabric of the village begins to erode. This erosion reaches its pinnacle when Noah Percy, played by Adrian Brody, stabs Lucius Hunt, played by Joaquin Phoenix, over jealousy of Mr. Hunt’s impending marriage to Ivy Walker, played by Bryce Dallas Howard. This stabbing and the different reactions to it offer three valuable lessons that can be applied to any community.
First, human nature has a base and evil element. This lesson is seen in Noah’s jealousy, which leads him to stab Lucius. Despite the effects of religion or different social constraints, humanity has base desires that will lead to civil unrest and societal disorder. The primitive innocence was not able to create the social conditions necessary to eradicate the evil desires in Noah’s heart.
Second, the village was founded on a “noble lie.” In Plato’s Republic, Socrates explains that the City in Speech – a utopia – must be founded upon a “noble lie,” which gives a false account of the city in order to trick the citizens into supporting the endeavor. Similarly, in this movie, we see that the village was founded on a noble lie. This noble lie was agreed upon by the elders in hopes of creating an innocent society without the presence of evil. As they discuss how to respond to Noah’s stabbing of Lucius, the village elders have to reveal the noble lies that the village was founded upon.
Finally, utopias are not founded upon reality. Given the previous two points, it stands to reason that a utopian society would be founded upon untruthful presumptions about human nature. It can thus be concluded that utopias would lack a proper conception of reality. As we see at the end of The Village, Ivy steps out of the woods and into a completely different, very modern world. By receiving the medicine needed to save Lucius from the real world, Ivy shows the inadequacy of the utopia and the importance of engaging with reality.
Here at GCO, we work to remove barriers to social and economic barriers to opportunity. As we learned through this discussion, it is futile to try to overcome these barriers without realizing the importance of grounding our solutions in reality. In our work, we hope to take into account the many barriers that are an every day reality for Georgians and tailor our solutions to provide opportunity that is grounded in that reality.
by Georgia Center for Opportunity | Jul 11, 2014
This is the second entry in a series of posts highlighting GCO’s new report, Increasing Access to Quality Healthcare for Low-Income Uninsured Georgians. The first entry provided an overview of the report .
Unfortunately, 19 percent of Georgians lack health insurance, the sixth highest percentage in the country in 2012.[i] Of the nonelderly uninsured, 56 percent live in households that make less than 139 percent of the federal poverty level (FPL), which is $16,221 for an individual and $33,151 for a family of four.[ii]
While it can be difficult for uninsured individuals to find care – particularly those with low-incomes – some uninsured individuals access care through Georgia’s healthcare safety-net. These providers include community health centers, charity clinics, public hospitals, local health departments, and private office-based physicians who provide limited free care.[iii]
Community Health Centers
The state’s community health centers provide primary and preventive care to many uninsured individuals on a sliding fee scale based on patient or family income. In 2011, Georgia’s Federal Qualified Health Centers (FQHCs) – local, non-profit, community-owned healthcare providers – served more than 317,000 patients at 152 delivery sites across the state. Of the FQHC patients, 51 percent were uninsured. The National Association of Community Health Centers estimates that 13 percent of Georgia’s low-income uninsured population was served by an FQHC in 2011.[iv]
Charity Clinics
Uninsured individuals in 90 of Georgia’s 159 counties have access to a charity clinic as another option to help meet their primary care needs. In 2012, the state’s 96 nonprofit, independent charity clinics served 183,625 unique patients, and 62 percent of these patients were below the poverty level.[v] Due to their volunteer nature, clinics are able to provide an average of $7 worth of services for every $1 invested, and the average cost per patient visit is $29.[vi]The total value of the services provided by Georgia’s charity clinics in 2012 was over $200 million.[vii]
Public Hospitals
In addition to community health centers and charity clinics, many uninsured patients seek care in hospital emergency rooms. Since many low-income uninsured individuals can only afford a small portion of the care they receive and hospitals are required to provide emergency healthcare to anyone needing it, providers are often uncompensated for the services they provide. In 2012, Georgia hospitals provided $1.6 billion in uncompensated care, including $936 million in free, indigent, and charity care and $671 million in care for which the patient did not pay his or her bill and was not qualified for the hospital’s indigent or charity care programs.[1],[viii]
[1] Uncompensated care is an overall measure of hospital care provided for which no payment was received from the patient or insurer. It is the sum of care for which the hospital never expected to be reimbursed and care for which it is unable to obtain reimbursement for the care provided, called “bad debt.” Uncompensated care excludes other unfunded costs of care, such as underpayment from Medicaid and Medicare.
[i] The Henry J. Kaiser Family Foundation, “Health Insurance Coverage of the Total Population,” accessed March 12, 2014, https://kff.org/other/state-indicator/total-population/.
[vi] Georgia Charitable Care Network, “Georgia Charitable Care Network – Partners in Georgia’s Safety Net,” Handout provided by the Georgia Charitable Care Network.
[viii] Georgia Hospital Association, Hospitals 101: A Resource Guide for Elected Officials, Fourth Edition, February 2014, 3, https://publications.gha.org/Portals/4/Hospital101UpdatedApril2014.pdf; American Hospital Association, “American Hospital Association: Uncompensated Hospital Care Cost Fact Sheet,” January 2013, https://www.aha.org/content/13/1-2013-uncompensated-care-fs.pdf.
by Georgia Center for Opportunity | Jul 1, 2014
Breakthrough Norcross, after nearly two years of working toward establishing a collective impact project to improve educational outcomes for Norcross students, partnered with Beaver Ridge Elementary to offer a Robotics camp for their rising fourth and fifth graders. Students who are interested in the subject of Robotics were able to sign up for a weeklong day camp over the summer, and, as a part of my summer internship with Georgia Center for Opportunity, I had the opportunity to check out what was going on at the Robotics Camp – dubbed Beaver Bots – last Thursday.
Environmentally, the robotics room is a collection of the parts, programs, and challenges for the robots that would be the primary tool of the weeklong camp. Two teachers facilitate the camp for approximately 30 students, who all spend most of their time in the robotics room. The Mindstorms, as the machines are officially named, are designed by Lego with the capacity to carry out a series of complex tasks. Various challenge courses are then set up in order to test the robots and their human operator through a diverse array of task completion.
The teachers lead each of the kids through the tasks at a very basic level that eventually handed over full reign of the robots and their programming to the kids. In fact, the teachers made it their mission to equip and not baby their students, and the kids loved it. The kids would cheer each other on through their successes and encourage each other through their missteps. Both boys and girls were learning to wrestle with the complex tasks assigned to them, and this development of perseverance – or grit as some call it – served as the crux for success in future tasks for the club.
One of the students was so excited about her experience there that she couldn’t help but exclaim how much she loved working with her friends and other students. She remarked that it wasn’t about winning or losing, although that was a component of the camp; but it was about trying your hardest and having fun with friends.
Of course, there were winners and losers, but the winners encouraged the losers, and the losers cheered on the winners; and everyone was having fun. Furthermore, and most significantly, the kids were not criticizing each other for their initial shortcomings on the challenge field. In fact, they outright refused to submit to failure, consistently returning to the drawing board until they found success.
Kids are playing with robots, encouraging each other, and carving a pathway into higher learning. It sounds utopic and in some regards it really is. It’s the start of something great, albeit unfinished. It’s just one small part of a larger story that’s unfolding through Breakthrough Norcross, and I have a feeling that the best is yet to come.
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This blog was written by Patrick DeMartino. Patrick is pursuing a B.S. in Psychology from the University of Georgia. This is his second summer interning with GCO working to support our Solution Delivery work.
by Georgia Center for Opportunity | Jun 30, 2014
Photo courtesy of St. Thomas More Catholic Church, https://www.stmaustin.org/catholic-single-parents.
When someone mentions the word homeless, what picture first comes into your mind? A person huddled under a bridge in a sleeping bag or lying on a park bench next to a grocery cart with a few belongings; or perhaps a person standing on the street corner holding cardboard sign that reads, “Hungry. Anything Helps.” While these are tragic pictures of the reality of homelessness in our country, many people are homeless in less overt ways all around us.
In its simplest form, a person is homeless if they lack stable housing.[i] This situation may include a wide range of circumstances, from living on the street, to staying in a shelter or transitional house, to doubling-up with family members or friends for a short period of time. The stark reality is that those who are homeless face instability, and this takes a toll on people, especially children.
Georgia has a number of organizations that work to address the issue of homelessness. One notable organization, Family Promise of Gwinnett County, Inc. (Family Promise), focuses specifically on addressing the needs of families that have become homeless due to a temporary change in circumstances like losing a job. This interfaith non-profit is part of a national organization founded in 1986 which has 182 local organizations nation-wide. Family Promise’s mission is “to mobilize communities of congregations that partner with social service agencies to end homelessness – one family at a time.”[ii]
Family Promise stands as one of the few shelter programs in Gwinnett that specifically target homeless families. Their emphasis on families as opposed to individuals is rooted in the reality that families with children are among the fastest growing segments of the homeless population.[iii] Estimates in Gwinnett County show that 60 percent of the homeless family population consists of children, and 50 percent of these children are under the age of six. This reality is reflected in the Gwinnett County School System which accommodated over 3,000 homeless students during the 2011-2012.[iv]
Georgia as a whole ranked 41st in the nation in matters related to child homelessness in 2010, having an estimated 45,566 homeless children.[v]
Most of the families served by Family Promise are single-parent households, and 60 percent of their guests have experienced situational homelessness before.[vi] Families must go through a thorough interview process to qualify for the 30 to 90 days shelter program, which involves a review of their work history, evictions, criminal background, and drug history. In addition, families must have a child under 18 years of age to qualify for the program, and at least one person in the household is required to have at least a part-time job during their stay.
Families stay in the program 51-55 days on average. They must move to a new host church every week as a way preventing them from becoming too comfortable and as a way of balancing the demand placed upon the host churches. Participants are required to actively search for a job and to work regularly once they obtain one. Typical jobs that participants obtain include fast food service, retail, housekeeping, landscaping, and customer service.
In 2013, Family Promise served a total of 38 families of whom 74 percent graduated from the program. Of these graduates, 55 percent had a job and 64 percent had a place to live upon leaving the program.[vii]
Chuck Ferraro, executive director of Family Promise, estimates that there are more than 400 churches of various sizes in Gwinnett. His job is to recruit these churches to be partners by agreeing to house up to four homeless families in their church building for one week out of the year. Currently, families rotate weekly among 30 Host Congregations in the network. Each host congregation is responsible for providing lodging, three meals a day, and general hospitality three to four times a year. Lodging consists of church classrooms and other open rooms in the building that can be converted into living spaces for these families during the week. Churches are able to do this in areas of their buildings that require limited use during the week.
Ferraro said that if he can get thirteen churches committed to housing a homeless family once a quarter, the needs of families that they serve could be covered for an entire year. However, getting churches to make this sort of commitment is a major challenge, he expressed. They are often pulled in a variety of directions when it comes to ministry focuses, and housing homeless families is not always a popular draw (despite the fact that caring for the poor is a central mission of the Church, he argues).
Nonetheless, Ferraro explained that there are ample opportunities for congregations to be involved in the work besides hosting families, and these include providing regular volunteers and funding. Volunteers are essential to the success of Family Promise as they provide a wide range of services that keep the program in operation, from cooking and serving meals, to playing with children and helping them with homework, to interacting with guests and providing overnight security.
As a way of addressing the needs of families beyond the immediate shelter program, Family Promise has created an aftercare program that supports families for up to a year after their time in the shelter program. Families who enter the aftercare program will receive case management, parenting and nutrition classes, and financial support that will help them on their pathway toward self-sustainability. The organization is looking to target twelve families per year for this program.
Addressing the needs of homeless families can be an overwhelming task. However, when members of a community join together to serve in the unique capacity that each is able, a tangible and significant difference can be made in the life and trajectory of a family.
[i] National Health Care for the Homeless Council, “What is the official definition of homelessness?” accessed June 23, 2014, https://www.nhchc.org/faq/official-definition-homelessness/.
[ii] Family Promise of Gwinnett County, Inc., “A Recovery & Sustainability Program for Homeless Families,” Brochure, received June 6, 2014.
[iii] National Coalition for the Homeless, “Who is Homeless?” Fact Sheet, July 2009, accessed June 23, 2014, https://www.nationalhomeless.org/factsheets/who.html.
[iv] Family Promise of Gwinnett County, Inc., “A Recovery & Sustainability Program.”
[v] Ellen L. Bassuk et al., America’s Youngest Outcasts 2010: State Report Card on Child Homelessness, The National Center on Family Homelessness, December 2011, 35, https://www.homelesschildrenamerica.org/media/NCFH_AmericaOutcast2010_web.pdf.
[vi] Interview with Chuck Ferraro, Executive Director at Family Promise of Gwinnett County, June 6, 2014.
[vii] Family Promise of Gwinnett County, Inc., “A Recovery & Sustainability Program.”
