Health & Well-being

Sex, Celebrity and the Inconvenience of Poverty

A closer look at life in Georgia

It was a cool afternoon in November 2014, as Ida carefully took hot cookies out of the oven. Shouting a stream of racially laced obscenities over her shoulder, she painted a stark opinion of the government and President Obama. Ida is not her real name, but it is the name she has been known by for more than fifty years in the same town, miles off the highways that crisscross through Georgia.

The stream of vulgarities belies the kind face with rosy cheeks and deep lines that provide evidence of what should be her retirement years. Ida was not retired, nor was she content. On this day, she directed her ire at President Obama and his “socialism” and how, she says, he ruined the country with the latest insult of “Obamacare”.  

Ida was one of the 15.8% uninsured residents of Georgia. Georgia ranked just behind Alaska and Texas for the highest uninsured rates in the country. In 2015, that rate improved slightly to 13.9%. Georgia lawmakers chose not to accept federal payments to help expand Medicaid coverage to their poorest residents, leaving people like Ida behind.

Henry Kaiser Foundation Healthcare Subsidy Calculator https://www.kff.org/interactive/subsidy-calculator/

Henry Kaiser Foundation Healthcare Subsidy Calculator https://www.kff.org/interactive/subsidy-calculator

Ida was not alone as her meager earning had to support, Emma, her seven-year-old granddaughter, that she was raising as her own.

Peachcare, the Georgia program to provide healthcare to children, had no providers within a two-hour drive for Emma. That was Ida’s first choice for economic reasons, but the reality of getting access to a doctor proved nearly impossible and Ida herself had not seen a doctor in over a decade.

Ida just wanted to be left alone and she isn’t proud, but today her agitation comes from what she says is, “asking for help”. She does not like it, but Ida had just achieved a milestone by landing a job at a big box store.

“It is just a few hours”, she says, “but they will give me a stool to sit on on account of the gout and my knees.” Ida has had trouble walking for years and can not stand for long periods. She looks far away for a moment and says finally, “Emma might be alone for a bit, but the neighbors are good people.”

After two hours of back and forth with her insurance consultant and the Healthcare.gov marketplace agent, Ida and Emma were finally fully insured in a health plan with a good network of doctors and hospitals nearby.

“Well now, this doesn’t work anything like they said it did,” Ida sighs. The relief is palpable and she smiles. “Now I can take Emma in for a checkup.” She laughs, “Maybe I will get around to finding myself a dentist, too.”

Ida and Emma got lucky. The rest of the state would see a steady decline in health outcomes and growing lack of access to care, even by those insured. All of this would be largely ignored by politicians and more affluent residents untouched by the plight of millions.

Georgia in Decline

The Center for Disease Control (CDC) ranks Georgia among the highest in declining health outcomes for low birthrates (4th), preterm births (5th), one of the highest infant mortality rates, and in births to unwed mothers (8th). One of the worst metrics for Georgian women is the state’s top ranking for maternal deaths and the ethnic disparity here is clear.

Georgia stands at 39.3 deaths per 100,000 live births with:
  • 12.4 deaths per 100,000 live births for white women.

  • 40.0 deaths per 100,000 live births for black women.

  • 17.8 deaths per 100,000 live births for women of other races.

The CDC defines maternal mortality as, “A pregnancy-related death is defined as the death of a woman while pregnant or within 1 year of the end of a pregnancy –regardless of the outcome, duration or site of the pregnancy–from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.”

In a 2018 report, USA Today investigative reporter Alison Young commented,  "Experts say that about 50 percent of the deaths of women from childbirth-related causes could be prevented if they were given better medical care and that's a really surprising thing given that we're one of the wealthiest countries in the world and we spend so much on medical care."

The United States now ranks at the top for maternal mortality overall (18% per 100,000 live births), with black mothers faring far worse outcomes than their counterparts in other ethnic groups.

That is not what Georgia legislators are focused on. Instead they are working on anti abortion legislation as are state houses across the country. This is despite the national abortion rate having dropped to the lowest point in over a decade, falling over 24% across the country with the majority (59%) of these procedures performed at the request of women with one or more children at home.

CDC Figure of abortion rate metrics

Figure 1 courtesy of CDC data https://www.cdc.gov/mmwr/volumes/66/ss/ss6624a1.htm?s_cid=ss6624a1_w#F1_down

Declining Outcomes and Rising Poverty

Georgians continue to have marginal health outcomes, at best, and current data shows a systemic worsening in areas that are preventable and treatable. Heart disease is still the leading killer among all health causes, followed by cancer, kidney disease and now Septicemia also tops the list.

Septicemia is caused by bacteria that enters the bloodstream from an untreated urinary tract infection, pneumonia, or other treatable ailments associated with bacterial infections. Georgia’s death rate for this is 15%, ranking at 9th highest in the country.

Disease Chart courtesy of CDC data, accessed May 11, 2019

Chart courtesy of CDC data, accessed May 11, 2019

“About 240,000 Georgians make too little to get financial help to buy health insurance on the Marketplace and don’t currently qualify for Medicaid. These Georgians are stuck in the coverage gap with no affordable health insurance options.”

Poverty rates are increasing across the state as well with one of every 5.9 residents living in poverty. Over 60% of Georgia’s impoverished are children and adolescents while 26% are adults from 18 -74 years of age. Of these, 11% are white, 26% Hispanic and 24% are black. Georgia is lagging in education attainment with just 49% earning high school diploma or GED, and less than 37% of the entire population holds a bachelor or higher degree.

Add to this the fact that millions across the state are still uninsured (20% of the total population), with the majority of these (82%) at or below the Federal Poverty Level.

Georgia Budget and Policy Institute, an independent, nonpartisan nonprofit organization, published a study, Georgia’s Coverage Gap, that reported, “About 240,000 Georgians make too little to get financial help to buy health insurance on the Marketplace and don’t currently qualify for Medicaid. These Georgians are stuck in the coverage gap with no affordable health insurance options.”

For people like Ida and Emma, Georgia is not enacting policy to help them and alleviate the cost for taxpayers across the state. What lawmakers are concerned about is abortion.

The ‘Heartbeat Bill’

The Washington Post covered the uproar last week over the passage of legislation dubbed, “The Heartbeat Bill,” meant to end abortions performed after six weeks of gestation, or around the time doctors may hear a heartbeat.

This law also prohibits abortion in the case of incest and rape or if the life of the mother is at risk. The law itself is not enforceable until 2020 and will be challenged in court. This indicates the true purpose of this bill – to provide a case that may ultimately challenge Roe vs Wade in the Supreme Court of the United States.

Mark Stern, writer for Slate, doubled down after taking criticism for his original coverage of the bill which asserted that the Georgia bill does, in fact, target women for prosecution in a unique way.

In a May 13, 2019 article Stern explained his argument:

“...The  law explicitly expands the definition of abortion to encompass self-termination. Georgia’s earlier abortion law defined abortion as something that one person “administers … to” or performs “upon any woman.” It was, in other words, something that one person does to another. HB 481 redefines abortion to be “the act of using, prescribing, or administering any instrument, substance, device, or other means with the purpose to terminate a pregnancy.” That means abortion includes something one person does to herself. A woman who takes misoprostol to induce miscarriage is “administering” a “substance” to “terminate a pregnancy” and is therefore liable under the law.”

If this interpretation is accurate, then women could be prosecuted and, under Georgia law, lose their right to vote while in prison or on probation.

Three other states have made similar efforts with legislation recently. Two such laws passed successfully in Ohio and Mississippi while Alabama’s version is still making its way through the state legislature. Neither the Georgia bill nor Alabama’s version directly mentions prosecution of women for having an abortion or for a miscarriage.

Washington Post reporters Deanna Paul and Emily Wax-Thibodeaux wrote, “The anti abortion legal and political community seems confident it has the votes to overrule Roe… but there are rules that govern when it’s appropriate for the Supreme Court to overturn a case. Courts generally abide by a doctrine known as stare decisis or respecting settled law. But the Supreme Court can revisit its precedents, which is what gives hope to abortion opponents.”

In fact, the Washington Post reported on twenty such cases that are all targeted to challenge and overturn the landmark SCOTUS decision legalizing abortion.

Under the Trump Administration, there have been 104 judicial appointments to federal courts and most all of these had bipartisan support. Among these were two Supreme Court Justices, 39 to justices appointed the U.S. Court of Appeals, 63 to U.S. District Courts and another 53 are currently waiting on Senate confirmations.

Why did the Georgia case lead news headlines and social media above all others? Celebrity status and social media played a big part in this.

Celebrity Clashes with Activists

Headlines over the last week were dominated with calls for a “Sex Strike” spearheaded by actress Alyssa Milano, who expressed outrage over passage of the Georgia bill.

Milano issued a call to action via tweet, "Until women have legal control over our own bodies we just cannot risk pregnancy. JOIN ME by not having sex until we get bodily autonomy back."

Milano has been living in Georgia for two years while filming the television series, Insatiable. Her tweet was met with immediate backlash by Georgia activists who had previously counseled the actress against her first effort, a call for a general boycott of the entire state.

Prominent Black female leaders in the activist and social work fields had asked Milano to be mindful of the negative effect a work boycott would have across the state, particularly in minority communities. Georgia offers generous tax credits to entice production studios to work in the state. AJC reported 2018 that revenues generated from over 400 projects topped $2.7 billion in direct spending. Past projects included The Black Panther and The Avengers films as well as Walking Dead and Milano’s own project.

twitter post by Anoa

Twitter @TheWayWithAnoa, https://twitter.com/TheWayWithAnoa/status/1127980758868680706

Heedless of the economic effect and council of local politicians like former Gubernatorial Candidate Stacey Abrahams, as well as activist Anoa, who writes a blog and hosts her podcast focused on socioeconomic topics from a black perspective, The Way with Anoa, Milano issued a call for a “Sex Strike” soon after. Activists had had enough and began pushing back.

The actress may have been well intentioned, but opponents argued that she was tone deaf, and refused to work with local allies, ignoring their good work. They argue that her continued push for a boycott or strike of some kind may jeopardize future efforts toward meaningful action.

In the end, it was clear that the focus was on a single draconian law while decades of work and struggle were ignored. This is similar to Republican lawmakers who proposed the legislation by choosing to focus on one issue while a clear threat to life and lack of access to quality care has been staring them in the face for over a decade.

In the end, people in the same economic situation as Ida and Emma will continue to be ignored and new and hopeful moms-to-be will continue dying for lack of access to quality care. Moms who suffer through a miscarriage may find themselves having to prove it wasn’t their fault, or as in other countries, be framed by ex-lovers or spouses who attest these women caused themselves to miscarry deliberately. With no way to prove otherwise, these women may then face the horror of a trial as well.

For now, Georgia taxpayers should prepare to fund a massive legal challenge on behalf of anti abortion interest groups.

Author's Update: On Wednesay, May 15, 2019, Alabam Governor Kay Ivey signed into law a bill that restricts abortion at any stage and imposes heavy criminal penalties of clinicians who participate in the procedure.

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