If you live in Georgia and buy your own health insurance, you may have already felt how fragile the system is.
Federal subsidies created under the Affordable Care have expired, causing monthly health insurance premiums to jump for millions of Georgia residents. Many Georgians have already seen sharp increases in what they pay for the same plans, sometimes hundreds of dollars more per month.
That sticker shock is not just a federal issue. It exposes how much Georgia relies on federal support while placing few limits of its own on health care costs.
🔑 Key Terms: When talking about this issue it can sometimes be difficult to keep track of all the terms used. Here is a quick breakdown.
- Affordable Care Act: This is the law that regulates the level of insurance health insurance companies must provide, tells them they can’t charge you more for preexisting conditions, and forces them to set out of pocket maximums. It also makes health insurance available to individuals through a healthcare marketplace. The Affordable Care Act was dubbed “Obamacare” by republicans, but they are the same thing.
- Health Insurance Marketplace: This is how the individuals who are not covered by employer-based insurance buy health insurance.
- Georgia Access: Georgia’s version of the health insurance marketplace.
- Medicaid: Medicaid is not the same thing as the Affordable Care Act. It is a government program that allows low income residents to have health care.
The health care you receive in Georgia is shaped by more than your doctor or your insurance company. It is also shaped by state laws.
Those laws decide who gets coverage, what hospitals are allowed to charge, and how much financial risk patients carry.
In Georgia, state law places relatively few limits on hospitals and insurance companies. Georgia is a business-friendly state, which often puts the laws in favor of large health systems and not patients.
In other states, lawmakers use state law to set clearer rules. The result is that patients in Georgia are more exposed to higher costs, fewer coverage options, and less predictable medical bills. This is not the case in other states, but is prevalent in the South.
Where Georgia Ranks on Basic Health Measures
Georgia consistently ranks near the bottom of states on measures that reflect how well people actually fare when they need medical care.
Georgia has one of the highest uninsured rates in the country. Millions of residents lack health insurance at some point during the year, which makes routine care harder to get and emergencies more likely.
Georgia also ranks near the bottom on preventable hospital visits. Many residents end up in emergency rooms for problems that could have been treated earlier and more cheaply in a doctor’s office if insurance coverage was more affordable and available.
The state has one of the highest rates of pregnancy-related deaths in the nation. Black women in Georgia face especially high risks during and after pregnancy.
Georgia also ranks poorly on chronic disease management, including conditions like diabetes and heart disease, which require regular care and affordable medication to control.
These rankings are not abstract. They reflect people getting sicker, waiting longer for care, and paying more when they finally get treatment. A sicker population that delays care due to cost increases prices across the board in terms of both insurance and cost of the care itself.
How Georgia’s Laws Affect Patients
Georgia has health care laws, but the state leaves many major decisions to hospitals and insurance companies. Other states have rules that govern health care and health insurance costs to make sure the residents of the state are getting decent health care.
Who gets coverage
Georgia does not allow most low-income adults to qualify for Medicaid, even though federal law gives states that option.
Instead, Georgia runs a smaller program that covers fewer people and requires work or job-related activities. Many adults who would qualify for coverage in other states do not qualify in Georgia.
When people are uninsured, they often avoid doctors and clinics until a problem becomes an emergency. They then go to the emergency room, where hospitals are required to provide care whether the patient can pay or not. Often, those bills are never paid. Hospitals make up that lost money by charging higher prices to insurance companies, which then pass those costs on to insured patients through higher bills and higher premiums.
What hospitals can charge
Georgia law does not limit hospital prices.
Hospitals and insurance companies negotiate costs privately. Patients usually do not know what care will cost until after treatment is complete, and even then, hospitals can come back years later after negotiations with insurance companies fail.
Protection from surprise bills
Georgia law now protects patients from certain surprise medical bills, especially in emergencies when patients cannot choose their doctors.
This law reduces the risk of unexpected charges that can cause long-term financial harm, but it does not address the high cost of care.
How Other States Use Law to Change Patient Outcomes
More people covered: Massachusetts
Massachusetts passed laws that made health insurance coverage a state goal.
As a result, Massachusetts consistently ranks near the top of states for overall access to care. It has one of the lowest uninsured rates in the country and fewer people who delay care because of cost.
More people with coverage means fewer unpaid hospital bills and less pressure to raise costs for everyone else.
More predictable hospital prices: Maryland
Maryland uses state law to control how much hospitals can charge. The state has standardized the cost of medical procedures. There are no private negotiations or separate costs for each insurance company. The price at one hospital is the same as the price at another and that doesn’t change based on what insurance you have.
The state consistently ranks among the better-performing states on hospital cost control. Patients are less likely to face extreme price differences for the same treatment, and hospital spending has grown more slowly than the national average.
Georgia does not regulate hospital prices.
Slower insurance cost growth: Washington and Colorado
Washington and Colorado require insurance companies to offer standardized plans.
Both states regularly rank above Georgia on measures tied to affordability and access. Fewer residents report skipping care because of cost, and insurance premiums have grown more slowly than in many states without similar rules.
What This Means for You
State health care laws influence:
- Your monthly premiums
- How much hospitals charge for care
- How predictable medical bills are
- How fast insurance premiums rise
States that use stronger health care laws actively shape what people pay, when they get care, and how sick they are when they finally see a doctor. States like Georgia that let the market drive health care costs, allow higher costs and wider gaps in care.
The Bottom Line
The health care you receive in Georgia is shaped by state law.
Other states have shown that laws can be written to protect patients more directly by expanding coverage, controlling prices, and limiting financial risk.
Georgia has chosen a more limited set of rules. That choice affects what patients pay and how secure their health care feels when they need it most.
Your lawmakers will be in session later this month. If you would like to see changes to health care in this state, those changes start at the state level, not the federal level.
🩺 Take Action: Georgia’s healthcare system won’t improve unless residents demand it. As a “business-friendly” state, Georgia often prioritizes the needs of businesses, including insurance companies, over patients — and that leaves many families behind. If you want better, tell your state lawmakers to invest in rural hospitals, expand access to care, and support programs that help mothers and children thrive.
B.T. Clark
B.T. Clark is an award-winning journalist and the Publisher of The Georgia Sun. He has 25 years of experience in journalism and served as Managing Editor of Neighbor Newspapers in metro Atlanta for 15 years and Digital Director at Times-Journal Inc. for 8 years. His work has appeared in several newspapers throughout the state including Neighbor Newspapers, The Cherokee Tribune and The Marietta Daily Journal. He is a Georgia native and a fifth-generation Georgian.
