As a graduate student, Stacy Soulimiotis is eager to finish her thesis and her degree, then get a job.
But these days she spends much of her time caring for her ailing mother, who is 78, ferrying her back and forth to doctor appointments, making sure she eats right, spending countless hours on the phone with her health insurance company.
The challenges of dealing with her mother’s illness and insurer are a daily reminder to Soulimiotis, 37, of her own inability to afford insurance. Without it, the Dunwoody woman said she wouldn’t know where to turn if she got sick.
“I got my car insurance bill the other day, and I thought gee, I’ve got car insurance, but I don’t have ‘me’ insurance,” she said.
Soulimiotis is one of roughly 1.8 million Georgians under the age of 65 without health insurance, giving Georgia the third-highest rate of uninsured people in the nation, according to a Gallup poll. The number has remained stubbornly large despite the Affordable Care Act and the launch of its Health Insurance Marketplace last year.
That’s in large part because the state opted not to expand Medicaid, the government health program for the poor. The marketplace also hasn’t had a substantial impact on the state’s uninsured rate. Indeed, early indicators show most of the nearly 317,000 Georgians who signed up for marketplace coverage in its first year already had insurance.
“There’s still a lot of work to do to reach those (uninsured) Georgians,” said Cindy Zeldin, executive director of Georgians for a Healthy Future, an advocacy group for the uninsured and others seeking improved access to health care.
Consumer advocates and health insurance navigators aim to reach as many of those uninsured as possible and get them enrolled when the marketplace’s second open enrollment kicks off Nov. 15.
‘A significant challenge’
Soulimiotis said she likes Obamacare. But the health plans offered through the federal insurance marketplace last year were too expensive, and she didn’t qualify for enough of a tax credit to lower the monthly premium to a level she could afford.
“If Medicaid had been expanded, I would have been able to have it,” she said. “But then on the other hand, there’s such a stigma attached to services, I would have felt guilty getting it.”
Statewide, roughly one in five people didn’t have health coverage in 2013. A recent Gallup poll shows the state’s uninsured rate has decreased by an estimated 1.2 percent since then.
Meanwhile, states that opted to expand Medicaid have seen much more dramatic declines. Arkansas and Kentucky saw the biggest drops in uninsured rates nationwide, falling 10.1 percent and 8.5 percent respectively, Gallup reported.
Language barriers, a lack of basic knowledge about insurance terms such as ‘co-pay’ and ‘deductible,’ as well as general inexperience with money make many of the uninsured particularly hard to reach and help enroll, advocates say.
“It’s certainly a significant challenge, but we are confident we can reach them,” said Ben Thomases, executive vice president for programs at Seedco, a nonprofit which oversees navigators. “There are still a lot of uninsured who are eligible.”
‘Didn’t try to enroll’
Across the state, dozens of so-called health insurance navigators will again help guide people through HealthCare.gov this year.
Navigators proved to be essential to marketplace enrollment efforts last year, according to a recent University of Georgia study on navigator programs.
“So many people (in the study) reported that they didn’t try to enroll until they had personal assistance,” Thomases said.
Some people also didn’t know how much money they had in their bank accounts at the end of the month. As a result, Seedco is now training navigators to ask more detailed questions so they can learn what consumers need to know going into the marketplace.
It’s also unclear how well the marketplace’s website, HealthCare.gov, will work the second time around. Its disastrous launch in October 2013 was plagued by numerous technological glitches that led to near-daily website crashes and foiled consumers’ efforts to apply for coverage.
Federal officials unveiled a revamped HealthCare.gov site last month and said the experience would be smoother and easier for consumers this year, though not completely glitch free.
Open enrollment for the marketplace runs for three months from Nov. 15 to Feb. 15. That’s half the length of time people had to sign up last year, and advocates worry people may be left behind.
‘Georgia’s uninsured problem’
Still, one of the biggest hurdles to lowering the number of uninsured Georgians is something that the advocates cannot change.
Under the law’s original vision, all states were supposed to expand Medicaid; the Supreme Court, however, ruled that the federal government could not force the states to expand the program. Gov. Nathan Deal has remained steadfast in his opposition to expansion, saying the state can’t afford to expand a program that’s already broken.
“Medicaid expansion will actually make (people) more dependent on the system,” said Georgia Rep. Jason Spencer, R-Woodbine. “It would cut jobs and lead to cuts in higher education.”
Spencer said he believes Medicaid won’t help uninsured Georgians and has vowed to work to reform the health care system.
“We have a broken model in Georgia and nationwide, and expanding Medicaid will only create more problems,” he said.
Medicaid currently provides care to roughly 1.8 million low-income children, pregnant women, the elderly and disabled in the state. Expansion would have extended that coverage to an estimated 650,000 Georgians, mostly adults without children.
Georgia would have seen a bigger drop in its uninsured rate had it expanded as other states did, said Bill Custer, a health policy expert at Georgia State University.
“Medicaid expansion has to be part of solving Georgia’s uninsured problem,” he said.
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This story was done in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.