A Look at Georgia’s Coverage Gap


By Daniel Thomas, Volunteer

As part of the Affordable Care Act (ACA), millions of Americans gained coverage through the implementation of Marketplaces for health insurance and Medicaid expansion. Medicaid expansion was meant to be a national policy as part of the ACA, however a 2012 Supreme Court decision made it optional for states, and currently only 18 states (including Georgia) have not expanded Medicaid, leaving approximately 2.4 million Americans without an affordable option for healthcare.1

What is the coverage gap?

The coverage gap refers to individuals in non-expansion states with income above current Medicaid eligibility levels but below the lower limit for ACA Marketplace tax credits. These individuals would be eligible for Medicaid if their state was to expand Medicaid, making it imperative states like Georgia expand Medicaid and close the coverage gap.

How does the coverage gap affect Georgia?

Approximately 240,000 adults in Georgia are in the coverage gap, and Georgia has the third worst uninsured rate in the country at 13.4% (and it is predicted to continue rising).2 Combined with high rates of obesity, diabetes, and cardiovascular disease in Georgia, the coverage gap puts a large and unsustainable strain on rural and safety net hospitals. Six rural hospitals have closed in Georgia since 2013, and more are vulnerable to close due to difficulties staying financially solvent.3,4

This results in the neediest communities having very limited access to appropriate healthcare, exacerbating health issues and forcing many rural Georgians to drive over 30 minutes to be seen by a doctor or in an emergency room. Georgia hospitals absorbed $1.74 billion in uncompensated care costs in 2015, and it is clear the state’s safety net systems will not be able to sustain themselves if drastic steps are not taken soon.5

Who does the coverage gap affect?

The majority of people in the coverage gap are poor working families and disproportionally people of color, specifically African Americans. In addition, the Urban Institute estimated 600,000 veterans did not have insurance in 2017, with 54% of them being in non-expansion states.6 The coverage gap affects historically vulnerable populations that have faced barriers in accessing healthcare, causing them to postpone much needed care and resulting in worse health outcomes for these populations.

What can I do?

Please share and utilize resources like Georgia Watch’s Guide for the Uninsured to do outreach and education to the communities that are most vulnerable. These materials provide many options to help uninsured individuals manage healthcare costs and find affordable care. Share the Georgia Consumer Guide for Medical Bills and Debt to help people manage their medical debt and understand their bills.

Lastly, volunteer, advocate, and donate to organizations like Georgia Watch that are fighting for a fair and equitable system for all Georgians. Georgians can’t afford another year of turning down billions of federal dollars that could be coming back to the state to stabilize struggling hospitals, create thousands jobs and provide health coverage to working Georgians. We must #CoverGA.

Georgia Watch will be offering educational workshops for uninsured consumers this summer, if you are interested in volunteering or bringing a workshop to your community, please contact Berneta Haynes at bhaynes@georgiawatch.org.

For more information and updates on the coverage gap and healthcare in Georgia, please visit Georgians for a Healthy Future and The Georgia Budget and Policy Institute. See also Georgians for a Healthy Future’s helpful consumer resources about the coverage gap.


Rachel Garfield and Anthony Damico. “The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid.” Henry J. Kaiser Family Foundation (November 1, 2017).

Annual Report: Georgia, 2017. America’s Health Rankings.

Laura Harker. Fast Facts on Georgia’s Coverage Gap. Georgia Budget and Policy Institute (January 2018).

4 Lauren Webber and Andy Miller. “A hospital crisis is killing rural communities. This state is ‘Ground Zero’.” Georgia Health News (September 22, 2017).

Lauren Harker. “Governor’s Vision for Georgia Omits Help for Struggling Health Care System.” Georgia Budget and Policy Institute (January 12, 2018).

Megan Wood. “Serving Those Who’ve Served: Close the Coverage Gap for Uninsured Veterans.” Community Catalyst (November 7, 2016).