Georgia's MUPs

In looking at areas without sufficient medical providers, HRSA designates areas as HPSAs, MUAs, or MUPs (see previous posts on HPSAs and MUAs).  This final map shows Georgia's Medically Underserved Populations (MUPs).  MUPs and MUAs use the same criteria, but an MUP designation evaluates a specific sub-population rather than an entire county.

Georgia's HPSAs

HRSA also designates areas as HPSAs, Health Professional Shortage Areas, based on a formula.

Georgia's Medically Underserved Areas

HRSA, the Health Resources and Services Administration, categorizes areas as MUAs (Medically Underserved Areas) if they score 62 or less on an Index of Medical Underservice.  This score is based on an area's ratio of physicians per 1000 population, infant mortality rate, percentage of residents living below poverty, and the percentage of the population aged 65 or older.  Here is a map of Georgia's MUAs showing that most of the state is medically underserved.

Georgia and the ACA

In 2014 Georgia had the dubious honor of being the only state with 2 of the 10 most expensive health insurance markets in the country.  Southwest Georgia ranks as the second most expensive market in the country after an affluent area of western Colorado (#1).  Centered around Albany, GA, this area has a number of factors likely playing into the expensive premiums there.  Neighboring southern GA has many of the same issues:

*These two markets are fairly rural.

*Georgia's legislature chose not to expand Medicaid to residents making 101-138% of the Federal Poverty Limit even though the Federal government pays 100% of the expansion costs for the first couple of years and 90% of the costs after that.  Rural hospitals in GA thus continue to have to treat uninsured poor patients and pass along the costs in higher costs to their insured patients and these insured residents' insurance companies.  Compounding this scenario is the fact that southwestern Georgia is served by a single hospital system.  In terms of seeking medical care, there is no other game in town.

*Southwestern and southern Georgia are fairly poor, rural areas with relatively high levels of chronic disease.  In other words, the populations of these areas are sicker and poorer than other parts of the state.  

The differences in average premiums between relatively affluent north Georgia/Atlanta and southern, rural Georgia earned Georgia the distinction of having the greatest disparities of any state in terms of insurance premiums.  

Last year was the first year in which the Affordable Care Act's (ACA's) new health insurance exchanges were operating.  Starting in 2014, almost all Americans must now have health insurance or face a tax penalty.

Premiums varied widely.  Today's map shows the 10 most expensive health insurance markets for 2014.  Citizens can purchase a variety of plans from different private insurers.  The standard for comparison looks at Silver plans for a 40 year old non-smoker.  In 2014, the average monthly health insurance premium for a Silver plan for a non-smoking, 40 year old adult was $328/month.  Rates were lowest in 2014 in Minnesota and highest in western Colorado.

So, are there any patterns to markets with high or low premiums?  Yes.

*Some fairly wealthy areas such as western Connecticut and western Colorado have relatively healthy people but appear to be paying more.  Why?  I guess because insurers feel the markets in these areas can bear higher premiums.  That is just a guess.

*Other areas are a) remote with limited medical providers, b) are in areas where Americans are in fairly poor health, or c) both.  Georgia has the dubious honor of having 2 of the 10 most expensive markets in the country AND having the greatest disparities of any state between the high costs around Albany, GA, compared to the relatively lower costs in the Atlanta market.  Wyoming, northern Nevada, western Wisconsin, Alaska, and coastal Mississippi all have issues with few providers and/or sick populations.

*Vermont ranks in the 10 most expensive because of a policy in that state.  Unlike in other states which have opted to allow insurers to charge older residents more than younger people, Vermont law requires insurers to charge everyone regardless of age the same premium for the same plan.  As a result insurers increased premiums across the board in Vermont.

The new 2015 premiums came out in mid-November and there are relatively big fluctuations in premiums.  Minnesotans will be paying more.  Mississippians will pay less.  Overall prices nationally are either slightly down or steady after years of rapidly rising premiums.  The geography of premiums, however, continues to be sorted out as insurers and their actuaries figure out if they are charging enough to cover the health issues of their populations AND make a profit (since the Republican-invented ACA model relies on government subsidies and private insurance companies rather than the single-payer Democratic alternative).  It will likely be at least 3 years (circa 2017) before we can see more stable premium data as the system finds its groove.

Collegiate Recovery Programs

Collegiate recovery programs are a new concept for me.  I discovered of their existence in 2014. Only about 50 U.S. colleges and universities offer these programs to support college students who are recovering from alcoholism and drug abuse.

If you consider the usual images of college social life, they often focus on heavy drinking and experimentation with illicit drugs.  College can be a tough place for a student in recovery.  Collegiate recovery programs help provide a range of services to assist students in recovery.  Most require a student to have been in recovery for a minimum of 6 months.  Some provide counseling.  Almost all seek to provide social gatherings and academic advising that take the special needs of students in recovery into account.

Georgia offers such programs at Georgia Southern University (with students from East Georgia College also served) and Kennesaw State University with a new effort/program at the University of Georgia.

This series of maps shows the classification of the state's 159 counties along a continuum from urban to rural.  This classification was developed by the US Department of Agriculture (by a fellow named Beale originally) and now is standardized by the US Office of Management and Budget (OMB).  It is based on urban population and commuting patterns for a county's workforce.  Thus, a rural county where a large percentage of the workforce commutes to a metro area would be classified as more urban than if its workers didn't access a more urban area regularly.

This map is a little rough.  I need to clean up some of the borders.  Here though is a map showing the Peach State's MSAs.  A Metropolitan Statistical Area is defined by urban population and workforce commuting.  

Georgia's AHECs

Most?  all?  states have AHECs (Area Health Education Centers).  This map shows Georgia's counties, health districts, and AHECs on one easy map.  

Georgia on My Mind

This next series of maps I'm starting to post today are ones I've made to help myself and colleagues who work in public health in Georgia.  This one shows Georgia's 159 counties.  Georgia has a boatload of counties; the second most of any state after Texas.  (Kentucky ranks 3rd by the way in the number of counties.)  Each county in Georgia has a health department which in turn is also part of 18 multi-county health districts.  

America's Only Majority Black Metro

The majority of Black Americans live in urban areas, but African-Americans make up the majority of the population in only one metropolitan area:  Albany, GA.

I've been on the road this past week, so here is a newly updated marriage map with a number of changes:

a. There are now only three states without a lawsuit seeking same-sex civil marriage:  Montana, North Dakota, and Alaska.

b. Georgia finally came on board the marriage lawsuit train as has South Dakota.

c. The 6th Circuit Court issued a stay on a Tennessee judge's order for the Volunteer State to recognize three same-sex couples as legally married while their lawsuit progresses.

d. One of the handful of out gay Federal judges heard a lawsuit seeking to overturn that state's anti-marriage constitutional amendment and legalize civil marriages there.  The state's attorney general also feels the amendment is unconstitutional and so there is no one defending the law before the court.

e. Alaska's Supreme Court also ruled this week that the state's refusal to give the same tax exemptions to same-sex couples as it gives to opposite-sex couples was discriminatory and unconstitutional.

f. And finally an Idaho cemetery for veterans refused the request of an elderly lesbian veteran to be buried with the ashes of her late partner under the claim that Idaho's state constitution prohibited recognition of the couple as married.  This woman who lived her life serving our country responded that she has spent her life being discriminated against and guess that this would not end with her death.  Sad.

Same-sex Marriage Lawsuits: The Holdouts

17 states now have same-sex civil marriages.  The Federal government recognizes legal same-sex marriages regardless of in which state a couple live.

In all but 9 of the other states, there are now active lawsuits seeking the state benefits of marriage and the ability to marry in these states.  The 9 holdout states listed in order of 2013 estimated populations are:

• Ohio, 11.6 million*
• Georgia, 9.9 million
• Mississippi, 3 million
• Kansas, 2.9 million*
• Nebraska, 1.9 million*
• Montana, 1 million*
• South Dakota, 0.8 million
• Alaska, 0.7 million*
• North Dakota, 0.7 million

Those states with an asterisk ("*") do not currently have lawsuits directly seeking the legalization of same-sex marriage, but they do have pending lawsuits involving related issues such as listing spouses on death certificates, listing step-parents on birth certificates, recognition under workplace law, foster parenting, etc.  These related lawsuits could impact marriage legalization overall.

So, the real holdouts are the couples in Georgia, Mississippi, and the Dakotas who have yet to file suit.

Map: What States Have the Most Discouraged Workers?

This map shows the variation in discouraged workers nationally.  Discouraged workers are unemployed Americans who have given up looking for a job for awhile and have not applied for any jobs in the past 4 weeks.

In no states does the percentage of discouraged workers exceed 1%, so the numbers are relatively low. This map calculates discouraged workers as the U4 unemployment measure by the Bureau of Labor Statitistics minus U3.  U4 consists of the official unemployment measure (U3) plus discouraged workers.  So I've pulled discouraged workers out and looked at the spread of data by standard deviations.

North Dakota's oil-fueled jobs boom continues to keep that state's unemployment the lowest in the US.  Nevada's 9.7% unemployment (U4 measure) is actually higher than South Carolina's 9.3% rate, but the Palmetto State has the highest percentage of discouraged workers in the country -at least in December 2013.  Neighboring Georgia, Alabama, and Florida also have higher percentages of discouraged workers compared to the mean for the United States.