Georgia's uninsured rate in 2014 fell by three percentage points, to 15.8 percent, mirroring a national trend linked to new coverage from the Affordable Care Act, the U.S. Census Bureau reported Wednesday.
But Georgia's percentage of people without coverage last year was the fourth-highest in the nation, trailing only Texas, Alaska and Florida.
Nationally, the percentage of people without insurance for 2014 was 10.4 percent, or 33 million, a big drop from the year before, when 41.8 million, or 13.3 percent, had no coverage.
Between 2008 and 2013, the national uninsured rate remained fairly stable, the Census Bureau noted. The biggest changes last year came from those directly purchasing insurance and from an increase in Medicaid enrollment, according to the report, considered the most consistent and complete picture of the nation's health coverage.
Georgia's drop from 18.8 percent was expected, said Bill Custer, a health insurance expert at Georgia State University. He cited the coverage newly available through the ACA and an improved economy in the state. But he also added, "Georgia is clearly lagging behind other states."
The report noted that the uninsured rate was higher in states that did not expand their Medicaid programs under the ACA.
More than half of the states have expanded Medicaid, making more low-income adults eligible for the program. But Georgia, along with most Southern states, has declined to do so, with political leaders citing the cost of such a move.
The ACA was fully implemented in 2014 with the debut of the insurance exchange, and Georgia's signups in that new marketplace surpassed 310,000. Also, the state's Medicaid and PeachCare membership last year increased by tens of thousands, as more outreach sparked by the ACA prompted individuals already eligible but not enrolled to join the two government programs.
But despite the overall decline in rates of uninsured people, some safety-net providers in Georgia said Wednesday that they have not seen a drop in demand for medical care from uninsured patients over the past two years.
Cathryn Marchman of Mercy Care, a federally qualified health center (FQHC) serving Atlanta's poor, said its percentage of patients without coverage has not changed. It remains more than 90 percent.
Statewide, Georgia's 34 FQHCs, which have 197 clinic sites across the state, saw an increase in the number of uninsured patients served last year. Overall demand for services by all patients is greater, added Duane Kavka of the Georgia Association for Primary Health Care.
And Grady Health System, which operates Atlanta's biggest safety-net hospital, said its percentage of "self-pay" patients has remained steady at 30 percent over the past three years.
Yet Jimmy Lewis, CEO of HomeTown Health, an association of rural hospitals in Georgia, said Wednesday that his membership has seen a slight uptick in insured patients, thanks to an increase in employment and more coverage through the insurance exchange.
Custer of Georgia State said Medicaid expansion would reduce the state's number of uninsured people significantly. He noted that California, which has expanded Medicaid, saw its rate of those without coverage shrink considerably. It's now at 12.4 percent.
"For decades, California had one of the largest uninsured populations," Custer said.