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Since 2021, Georgia Watch, Georgians for a Healthy Future (GHF), and SOWEGA Rising have worked to protect consumers in Southwest Georgia from unaffordable medical bills and debt through the Community Benefit and Economic Stability – Georgia (CBES-GA) project with support from leading health advocacy organization, Community Catalyst. Southwest Georgia experiences medical debt at a higher rate than the rest of Georgia and the country, particularly in communities of color. Southwest Georgia also has some of the highest insurance premiums in the country due primarily to the lack of competition among providers and insurers. This level of consolidation leaves consumers with little choice about where to seek care and incentivizes predatory medical billing practices. In Dougherty County, 25% of black residents have a medical bill in collections, compared to 21% in Georgia and 17% nationally (Urban Institute, 2020), creating significant barriers to care and trapping already cash-strapped Georgians into a cycle of poverty.  

“The medical debt burden disproportionately impacts black and brown people due to unfair and discriminatory barriers to health coverage and economic security, noted Sherrell Byrd, Executive Director of SOWEGA Rising. “Particularly in rural Georgia, you will see the highest rates of medical bills which drives up insurance costs, creating barriers to people who have to choose between paying bills and seeking necessary medical care.” 

Leveraging the policy expertise of Georgia Watch and GHF, as well as the local knowledge and community trust of SOWEGA Rising, the CBES-GA team has aimed to protect consumers in Southwest Georgia from unaffordable medical bills and debts so that all Georgians can afford the care they need. As this phase of the project winds down in the summer of 2022, we are reflecting upon all we have accomplished and how we will continue the work.

Dish the Debt Campaign

Changes in legislation ultimately leading to more affordable healthcare and less medical debt are greatly influenced by consumers’ personal stories. To better understand the individual and community impacts of medical debt, the CBES-GA team launched the Dish the Debt campaign to encourage community members, especially people of color disproportionately impacted by medical debt, to share their stories. Throughout the campaign, the team collected consumers’ stories and experiencesto translate into policy recommendations for hospitals and state leaders that alleviate the impacts of medical debt. The CBES-GA team also hosted a Facebook Live virtual forum with a panel discussion about the issue of medical debt, ways hospitals can help people avoid unaffordable medical bills, information about hospital community benefit and financial assistance, and a call to action to share medical billing stories. 

In March 2022, the CBES-GA team visited the town of Cuthbert, GA, for an in-person Dish the Debt listening session. Amidst the COVID-19 pandemic in October 2020, the Southwest Georgia Regional Medical Center in Cuthbert closed after over 70 years of service, leaving Cuthbert residents without access to essential healthcare. The team met with community members and key leaders to discuss the impacts the hospital closing has had on healthcare access in the area. Prior to the hospital’s closing, residents enjoyed the convenient care and myriad of services available to them locally. However, Cuthbert’s entire medical infrastructure dissipated when the hospital closed. The closest emergency room is Phoebe Putney Memorial Hospital in Albany, GA, forcing Cuthbert’s residents to travel roughly an hour for both emergency treatment and non-emergent care. Understanding the personal stories of those impacted by the hospital closing and subsequent community health impacts has been instrumental in shaping our recommendations for hospital systems and lawmakers. 

Engaging in the Community Health Needs Assessment

As mentioned, a quarter of people of color have a medical bill in collections in Dougherty County, home to the city of Albany and Phoebe Putney Memorial Hospital. As a nonprofit hospital, Phoebe Putney is required by the Affordable Care Act (ACA) to conduct a community health needs assessment (CHNA) every three years. Through the CHNA process, information is collected from stakeholders, community leaders, and secondary sources about the status of the community. Community health needs are then prioritized based on the needs assessment findings, and hospital programs are implemented to target the prioritized community health needs. Community members the hospital serves must have a seat at the table during the CHNA process to ensure critical health needs are accurately identified. 

The CBES-GA team engaged with Phoebe Putney’s CHNA Internal Work Team to encourage the hospital to prioritize strategies and programs that reduce medical debt. SOWEGA Rising Executive Director Sherrell Byrd was interviewed during the CHNA process about pressing needs in the community. During the interview, Byrd discussed racial inequities with high medical debt, social determinants of health in communities, lack of maternal and mental healthcare in the region, and the lack of transparency around the costs for medical services. Having SOWEGA Rising at the table to uplift community voices in the CHNA was a powerful step in addressing disparities throughout Phoebe Putney’s five-county service area. 

Medical Debt Panel with the CFPB

In March 2022, the CBES-GA team was invited to participate in a virtual panel discussion about the complex challenges surrounding medical debt in Georgia, hosted by the Consumer Financial Protection Bureau (CFPB). CFPB Director Rohit Chopra was joined by United States Senator Jon Ossoff (D-GA) and Georgia advocates, including Liz Coyle of Georgia Watch, Laura Colbert of Georgians for a Healthy Future, and Sherrell Byrd of SOWEGA Rising. The group discussed crucial topics such as racial justice in healthcare access, the harms of medical debt, and the importance of examining policy solutions through an equity lens, bringing national recognition to the issue of medical debt in Georgia. The conversation also resulted in robust reforms to credit reporting practices, including paid medical debts that were in collections no longer being included on consumer credit reports.

You can view the panel discussion HERE with the password ‘CFPB220303GA’.

Future Opportunity

While this phase of the CBES project is wrapping up, more work is needed to ensure all Georgians have access to quality, affordable healthcare. In collaboration with Southwest Georgia community groups and healthcare providers, CBES-GA is continuing our efforts to increase patient confidence that healthcare is available at an affordable cost, ensure billing and collection practices are fair and transparent, and align hospital community benefit spending with community health needs. 

As a part of this mission, the CBES-GA team developed a Civic Advocacy and Engagement training curriculum to empower community members to become stronger advocates for the health of their communities. This curriculum equips individuals with the knowledge necessary to engage in the CHNA process and with local and state policymakers in Georgia about the crushing impacts of high healthcare costs and medical debt. To emphasize the significance of CHNAs in shaping community health, the curriculum includes the module What is a community health needs assessment (CHNA)? And why is it important? The module guides participants through the phases of the CHNA process and how they can get involved in their own hospital’s CHNA to impact the health of their communities. The curriculum implements a “train-the-trainer” model so that the project’s reach can grow organically, teaching more advocates about uplifting the voices of their communities. 

CBES-GA also hosts Policy Workshops to provide a platform for community members to apply what they learned in the Civic Advocacy training. These workshops help community members turn policy ideas into action by guiding them through the process of crafting a policy pitch with the help of subject area experts. At the end of each workshop, participants present their issue to policy experts who provide constructive feedback, further equipping them with the skills needed to engage in the CHNA process and with policymakers throughout the state.

We are incredibly proud of what we have accomplished together to protect Georgians from unaffordable medical bills and debt through the CBES-GA project. Georgia Watch, Georgians for a Healthy Future, and SOWEGA Rising are committed to continuing to address the disparate impacts of medical debt on communities of color through ongoing community relationships, advocacy training, and capacity building in Southwest Georgia. 

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If you are interested in participating in or hosting a Civic Advocacy training or Policy Workshop, please contact Natasha Taylor (ntaylor@georgiawatch.org) or Sarah Phillips (sphillips@georgiawatch.org) for more information.