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Motherhood in the U.S. can be dangerous. The nation spends more on healthcare than any other high-income country. But women giving birth here — particularly Black women, and particularly in Georgia — are more likely to die in childbirth. A big reason for this maternal mortality crisis is a lack of access to obstetric care.

“Georgia has a problem with access to care — the whole country does,” said Meghan Meredith, a fourth-year Ph.D. student in the H. Milton Stewart School of Industrial and Systems Engineering (ISyE) who has spent much of her academic career studying the problem, which is particularly acute in rural, lower-income places.

Many of these places have been designated “maternity care deserts” by the March of Dimes. If a county doesn’t have any obstetric care or providers, it’s considered a desert. Another commonly used measure is whether a pregnant woman lives within 50 miles of critical care obstetrics (CCO). 

These measures are often referred to in academic literature and popular media to highlight a lack of healthcare access, and by public policy leaders trying to address the issue. But it’s become evident to Georgia Tech researchers that they just don’t add up.

“These measures don’t capture the complete picture,” said Meredith. “They aren’t an accurate representation of access to care.”

And that’s what concerns Meredith and her faculty advisor, ISyE Assistant Professor Lauren Steimle.

“We’ve been interested in access to maternal care for a long time, and in countless news stories, the maternity care desert measure is reported on,” Meredith said. “We recognized the limitations, so we thought, ‘Let’s write a paper that explains how this measure is not a complete representation of access.’”

They published their work recently in the journal BMC Health Services Research.

Modeling the Landscape

To study these measures of access, Meredith and Steimle used the same kind of computer-based mathematical model that helps companies decide where to place a new distribution center, retail outlet, or even electric car charging stations: a facility location model.

“This model helps us determine where to place facilities, so demand is sufficiently covered with the fewest number of facilities,” said Steimle. “There are tons of potential applications for this model, but we’re using it for healthcare.” For this study, they used the model to identify where Georgia would need to expand healthcare facilities to improve access under the commonly used measures. 

Here’s some of what the researchers found:

• Of the 1,910,308 reproductive-age women in Georgia, 104,158 (5.5%) live in maternity care deserts, while 150,563 (7.9%) live more than 50 miles from CCO services; 38,202 live in both situations.

• Fifty-six counties in Georgia meet current “maternity care desert” measures, which means eliminating these deserts would require 56 new obstetric hospitals. That would increase the number of obstetric hospitals statewide from 83 to 139 (a 67% increase). 

• Strategically expanding 16 hospitals (a 19% increase) would reduce the number of reproductive-age women living in deserts by half.

• 82% of reproductive-age women designated as living in maternity care deserts live within 25 miles from an obstetric hospital.

The researchers conclude that policymakers should be warned: Using the maternity care desert measure alone as a basis for where and how to invest in healthcare resources isn’t a great idea.

“If we really want to improve pregnancy outcomes, our measures of access should promote risk-appropriate and regionalized care systems,” Steimle said.

Turns out, Georgia is already headed in that direction.

Counting Counties: One Size Doesn’t Fit All

To illustrate the problems with the maternity care desert measure, Steimle compared Georgia with a very different state on the opposite side of the U.S.: Nevada.

“A major problem with the maternity care desert measure is its emphasis on county-by-county infrastructure,” she said. “It’s a one-size-fits-all approach that doesn’t tell the whole story about access to care.”

For example, Georgia has 159 counties and more than three times the population of Nevada. Meanwhile, Nevada has twice the square mileage of Georgia — and 16 very large counties. 

At 18,147 square miles, Nye County is Nevada’s largest, and it’s been labeled a maternity care desert. There’s also lots of actual desert in Nye, which is larger than nine U.S. states. So, it’s difficult to accurately compare a vast jurisdiction like Nye with, say, central Georgia’s Lamar County. Lamar, also labeled a desert, is a mere 185 square miles in size. It’s also surrounded by counties that are veritable oases of care.

“A lot of people in Georgia may be falsely labeled as not having access, at least geographically speaking, when in fact they have services nearby,” noted Steimle. “Meanwhile, in a state like Nevada, some women may be labeled as having access, but might be very far from obstetric hospitals in their county.”

Steimle also point out that measuring access on a county-by-county basis ignores efforts to coordinate care across the whole state. “The maternity care desert model doesn’t hold up. And it doesn’t reflect Georgia’s approach to a regionalization system.”

Since 2009, the Georgia Department of Public Health has organized the state into six geographic perinatal regions (the perinatal period covers pregnancy, childbirth, and early postpartum). The idea is to coordinate the delivery of health services to ensure people in all regions have access to risk-appropriate maternal care.

Build a Better Model

Each of Georgia’s perinatal regions has a “hub” — a major care center serving as an administrative unit to enable the coordination and delivery of maternal care services. For example, The Emory Perinatal Regional Center at Emory University Hospital is the coordinating center for the 39-county metro Atlanta region. 

This regionalization strategy also tries to address the problem of hospital closures, a troubling trend that leads to more deserts. In Georgia, 12 hospitals have closed since 2013; 18 rural hospitals are currently at risk of closure. And this new Georgia Tech study indicates that Georgia would somehow need to add 56 new facilities to eliminate the state’s maternity care deserts — at least by the standards used by the March of Dimes.

“Eliminating maternity care deserts in Georgia would mean adding a larger number of obstetrics facilities to make sure every county has an obstetric hospital,” Steimle said. “But this is likely unrealistic with the current economic forces pushing hospitals to close their obstetric units. With that many facilities in Georgia, some facilities would have a very small number of deliveries, which is not economically sustainable.”

In other words, eliminating maternity care deserts in Georgia wouldn’t sufficiently address the larger problems related to access to care. Instead, Steimle and Meredith advocate for approaches that simultaneously consider the different dimensions of an ideal maternal healthcare system, not just access alone.

For this initial study, Steimle and Meredith just focused on spatial access. They haven’t yet addressed the complex issues of racial disparities, insurance access, or other hurdles facing reproductive-age women in Georgia. That may be coming.

“This is a start,” Steimle said. “Our future work entails thinking about how to come at this with the goal of maximizing or improving outcomes for women.”

And as policy leaders across the country begin to address the maternal mortality crisis, Steimle believes her team’s approach using more sophisticated tools can be helpful. So far, they’ve shared their results with the Centers for Disease Control and Prevention, and members of the Georgia, Iowa, and Nevada departments of public health.

“How do we make measurements that point us toward our end goals? Our tools as mathematical modelers can really help us think through the system holistically and think through strategies before trying them in the real world,” Steimle said. “Think of it as a policy sandbox.”

CITATION: Meghan Meredith, Lauren Steimle, and Stephanie Radke. “The implications of using maternity care deserts to measure progress in access to obstetric care: a mixed-integer optimization analysis.” BMC Health Services Research (June 2024)

– Autism Toolkit is making Autism resources more accessible with its new online directory tailored for rural communities in Georgia. This innovative directory includes a virtual map and easy-to-navigate search filter, providing better access to those impacted by Autism in these underserved areas.

In rural Georgia, families often face significant challenges in accessing Autism support. The Autism Toolkit Online Directory was created to bridge this gap, serving as a centralized information hub. By consolidating various resources in one place, the directory ensures families can quickly and easily find the services they need.

Users can easily navigate through various types of support, such as applied behavior analysis, diagnosis, financial assistance, school services, various physical and mental therapies, and more. The Autism Toolkit Online Directory is designed to allow users to tailor their search to specific regions across Georgia, as well as neighboring states like Florida, South Carolina, and Tennessee. These search features enable users to find the most relevant services for their needs.

Autism Toolkit, founded by Sarah Rotschafer, Ph.D., and faculty members at Mercer University School of Medicine, is dedicated to supporting the neurodivergent community in rural Georgia. In addition to the new directory, Autism Toolkit offers educational materials, virtual tools, and personalized referrals. These resources empower families with the knowledge they need to navigate the complexities of Autism care.

With the launch of this directory, Autism Toolkit is committed to improving the lives of those affected by autism in rural Georgia. The organization aims to be a trusted place for parents and caregivers to find answers and support, fostering a sense of community and connection.

In case you missed it, a report recently released by the Georgia Public Policy Foundation examined the health insurance marketplace in Georgia since Governor Kemp took office.

The report acknowledges that Georgia’s health insurance landscape was “dire” when the governor was sworn into office in 2019, but has seen “dramatic improvements” as a result of the state’s decisions and approach towards addressing the need for greater access to healthcare coverage.

Analyzing waivers submitted by Governor Kemp that established both Georgia’s reinsurance program and state-based exchange called Georgia Access which are currently being run by Georgia Insurance Commissioner John King, the report concludes that “other governors should emulate Kemp’s success if they wish to seize power back from Washington, D.C., bring revenue to their states and use the power of the private sector.”

Read more here.

Examining Georgia’s health insurance marketplace

Gregg Conley, Georgia Public Policy Foundation

…

When Gov. Brian Kemp was sworn into office on January 14, 2019, the health insurance landscape in Georgia was dire. Since then, that landscape has seen dramatic improvements thanks to decisions that put the interests of our state and its citizens first. One-and-a-half terms later, it is worth highlighting and explaining the Kemp administration’s extraordinary successes in the health insurance world, as well as offering potential next steps in building on that success.

Most Georgians receive their health insurance through employer-sponsored plans. However, approximately 10% of our residents do not have access to an employer-sponsored plan and rely on the individual health insurance market to obtain coverage. In 2018, a Georgian looking for coverage on the individual market faced significant challenges, mainly due to a lack of insurers. A lack of choice creates significant costs for the individual consumer. In 2018, only four health insurance carriers operated on the individual market, and 145 of our counties had only one health insurer, while the other 14 had only two.

Having only one insurer in 145 counties means no significant market competition is taking place. This lack of competition also means providers were forced to accept the terms of the only insurer operating in their county, leading to lower reimbursement rates. This lack of competition resulted in higher insurance rates and consumers paying more than they usually would, or having to go without insurance due to the cost. In 2019, over 1.5 million Georgians eligible for individual market plans were uninsured.

…

Gov. Kemp’s 1332 waiver was approved in November 2020. Effective January 1, 2022, through December 31, 2026, the federal government funds two-thirds of the program’s cost, with the state providing the rest. Under the waiver, Georgia reimburses health insurers selling individual market plans for a percentage of claims above a certain amount. This helps control insurer costs and leads to lower premiums.

The reinsurance program stabilized and lowered premiums in the market. In 2023, statewide premiums were reduced by 12.4%. Moreover, in Georgia’s most rural counties, premiums in 2023 were reduced by 34.3%. Besides lowering prices for consumers, insurers were encouraged to come back to the state. The increased competition also led to lower premiums.

These are spectacular successes by any measure. In contrast to 2018, when 145 Georgia counties had only one carrier and the other 14 had only two, now only one county has as few as two carriers. Sixteen percent have at least three, 31% have four and over 52% have five or more. Moreover, in 2018 there were only four carriers participating in Georgia’s individual market, but now in 2024 there are 10. The state reinsurance program has greatly increased citizens’ health insurance choices while dramatically lowering premiums.

…

The other equally impressive accomplishment of the Kemp administration has to do with the spectacular growth in enrollments in individual health insurance plans Georgia has seen. This is due in large part to the establishment of a state-based healthcare exchange for the benefit of Georgians. Georgia Access is the first of its kind and utilizes private-sector efficiencies to offer maximum choice to Georgia citizens.

…

Georgia Access is a pioneering, conservative way to navigate our current health insurance market – one that takes power back from Washington, D.C., empowers Georgia, brings revenue back to our state and utilizes private business to benefit our citizens.

“Yes, that’s all fine,” one might say. “But does it work?” The numbers speak for themselves. In 2019, approximately 375,000 enrolled in plans on the individual market. In 2024, that number rose to approximately 1.3 million. This means that during the Kemp administration, approximately 1 million more Georgians have enrolled in health insurance plans on the individual market. This astounding statistic means that about 9% of the total population of the state gained health insurance due to the Kemp administration’s Patients First Act.

Kemp’s tenure in office has seen statewide health insurance premium reductions for individual market plans of 12%, with reductions rising as high as 30% in rural areas. Moreover, 1 million Georgians, or 9% of the state’s population that previously did not have health insurance, have obtained it during the Kemp administration. Not only has Georgia carved a path forward for health insurance innovation for its citizens, it has also blazed a trail for other states.

Other governors should emulate Kemp’s success if they wish to seize power back from Washington, D.C., bring revenue to their states and use the power of the private sector. They would also position their states to better weather national elections whether they are contending with a Democratic administration increasingly hostile to state sovereignty or a Republican administration looking to de-emphasize federal bureaucracy. The creation of a state-based exchange puts governors and state legislators back in the driver’s seat of their state health insurance markets.

In Q2 2024, Atlanta’s coworking supply continued to grow, now standing at a total of 226 spaces.

CoworkingCafe’s latest coworking industry quarterly report leveraged the most recent proprietary data (June) to break down the coworking space stock availability in the 25 largest markets. To get a more granular overview of the coworking market, we also looked at the spaces’ size and distribution, the prices and the leading operators.

We also compared the most recent numbers to those registered in the first quarter of 2024 to determine the industry’s evolution throughout the nation.

Here’s how the coworking market performed in the last quarter:

• Atlanta saw a 5% increase in the coworking spaces supply. This translates to 10 more coworking spaces. The market kept its 7^th spot nationally.

• In terms of total square footage, Atlanta dropped to the 8^th nationwide with 4.36 million sqft., a very small decrease of 0.3% compared to Q1.

• The average sqft. in Atlanta dropped by 5% from 20,241 sqft. in Q1 to19,295 sqft. in Q2.

• In terms of pricing, virtual offices dropped $28, now standing at $148. Dedicated desks decreased by $5, now reaching $289 and open workspaces remained at $139.

You can read the full industry report at www.coworkingcafe.com

 Oglethorpe Power is going all-in on natural gas as a source of electrical generation.

The Tucker-based utility, which serves 38 electric cooperatives, announced plans Thursday to build two new natural gas projects in Monroe and Talbot counties.

The larger of the two, to be located in the city of Forsyth, will produce about 1,200 megawatts of electricity on land Oglethorpe Power already owns. Representing a $2 billion investment, the new facility will be among the highest-performing, lowest-emitting and most efficient natural gas plants in Georgia, the utility wrote in a news release.

The second project will be constructed at an existing plant in Box Springs. The 240-megawatt unit will represent an investment of about $360 million.

The additional generating capacity is necessary to keep pace with Georgia’s rapid growth, said Mike Smith, Oglethorpe Power’s president and CEO.

“The electric cooperatives we serve need more energy capacity to meet their increasing demand,” Smith said. “These two new natural gas projects demonstrate growth in Oglethorpe Power’s generation portfolio and our focus on reliable, affordable and sustainable energy for our members.”

The company will release a timeline for both projects once all necessary permits have been obtained.

Capitol Beat is a nonprofit news service operated by the Georgia Press Educational Foundation that provides coverage of state government to newspapers throughout Georgia. For more information visit capitol-beat.org.

 Cloud Theory, the real-time automotive data insights provider for automotive manufacturers, agencies, and affiliates is reporting in June’s On The Horizon report that new vehicle movement hit 1.2 million for the first time since May 2021. While June numbers are expected to fall back slightly, the industry continues to show strength through its sales trajectory over the past several months.

This growth is largely being driven by continued momentum in new vehicle inventory, which grew 2.8% MoM in May and now sits at 2.89 million.

Turn rates remained in their recent narrow range at 40%, and that metric has been in the high 30s to low 40s since November 2023. New vehicle marketed prices, which had been declining since July 2023, ticked up for the second straight month and rose above the long-term trendline.

“The flat turn rate trend indicates that gains in movement are the result of increased supply rather than from higher sales efficiency,” said Rick Wainschel, Vice President of Data Science & Analytics at Cloud Theory. “More supply means more competition for OEMs, and the recent ramp-up in incentives levels will need to continue in order to maintain the recent industry momentum.”

Toyota Motor Corporation asserted its dominance in terms of Inventory Efficiency Index, with Toyota and Lexus in the top two spots nationally and in 7 of the 9 regions.  However, the way those two brands demonstrated that strength differed in May. Toyota’s vehicle movement increased slightly (+1% MoM) even though its average inventory position degraded by 8%. Lexus, on the other hand, saw its movement jump by 34%, which far surpassed its supply growth (+5%), resulting in an increase in its score.

“Toyota Motor Corporation’s May performance demonstrates that there is more than one path to sales efficiency,” said Ron Boe, Chief Revenue Officer at Cloud Theory, “but the strength shown by both Toyota and Lexus speaks to the power of their two brands in the marketplace.”

To see more trends and forecasts on inventory, movement, segment trends, and inventory efficiency, download a copy of the June 2024 On the Horizon report here.

Cloud Theory’s On the Horizon report puts proprietary, real-time data into a historical context, so automotive OEMs can view and understand critical insights that help make decisions involving allocating marketing and incentives dollars.    

Georgia Council for the Arts received applications from arts organizations from across the state, including performing arts centers, museums, galleries, amphitheaters, and music festivals. Bridge Grants are available to arts organizations for eligible operating expenses like rent, utilities, programming expenses, and marketing. 

“We’re thrilled to receive the Bridge Grant from the Georgia Council for the Arts,” said Spruill CEO Alan Mothner. “This support means we can bolster our programming and keep offering the enriching cultural experiences that make such a positive impact on our community.”

Funding for these grants is provided through appropriations from the National Endowment for the Arts and the American Rescue Plan (ARP).

Georgia Council for the Arts (GCA) uses Peer Review Panels to judge and review applications following standard practices set by the National Endowment for the Arts. Panelists are GCA Council members and fellow professionals who are experienced in the arts discipline or type of grant being reviewed, or are citizens with a record of arts activities, experience, and knowledge.

Capitol Beat is a nonprofit news service operated by the Georgia Press Educational Foundation that provides coverage of state government to newspapers throughout Georgia. For more information visit capitol-beat.org.

Legislation establishing independent oversight of the federal prison system introduced by two members of Georgia’s congressional delegation is on its way to President Joe Biden’s desk.

The U.S. Senate gave final passage to the bipartisan bill on Wednesday. The House of Representatives already had passed the measure in May.

The legislation requires the Justice Department’s Inspector General to conduct comprehensive inspections of the federal Bureau of Prisons’ 122 correctional facilities and provide recommendations to fix whatever problems it uncovers. The bureau will have 60 days to respond to all inspection reports with a corrective action plan.

The bill also establishes an independent ombudsman to investigate the health, safety, welfare, and rights of incarcerated people and staff. The ombudsman’s office will create a secure hotline and online form for family members, friends, and representatives of incarcerated people to submit complaints.

“This is a major milestone,” said Sen. Jon Ossoff, D-Ga., who led an investigation into the federal prison system two years ago. Ossoff joined Republican Sen. Mike Braun of Indiana in introducing the bill.

“My bipartisan Senate investigations of corruption, abuse, and misconduct in the federal prison system have revealed an urgent need to overhaul federal prison oversight,” Ossoff added. “I now look forward to President Biden signing our bipartisan bill into law.”

U.S. Rep. Lucy McBath, D-Marietta, joined Republican Rep. Kelly Armstrong of North Dakota in introducing a companion bill in the House.

“The passage of my federal prison oversight legislation in the Senate marks a new step forward in ensuring accountability to protect staff and incarcerated individuals in our federal prisons,” McBath said Wednesday. “When Republicans and Democrats come together, we can deliver common-sense solutions for the American people.”

Georgians with incomes too high to qualify for Medicaid but not enough to afford private health insurance would receive temporary federal subsidies under legislation introduced by U.S. Sen. Raphael Warnock, D-Ga.

The Bridge to Medicaid Act would replace federal tax credits due to expire in 2026 with premium subsidies to help people with incomes between 100% and 138% of the federal poverty level buy health coverage in the private market. The subsidies would continue for three years to give policymakers in Georgia and other states that have not expanded Medicaid time to debate the issue.

“Health care is a human right,” Warnock said Thursday. “In the richest nation in the world, it’s a travesty that there are still hundreds of thousands of Georgians who don’t have access to the affordable health care they need due solely to the craven decisions of state politicians.”

Georgia’s Republican governors and the GOP-controlled General Assembly have opposed Medicaid expansion since a Democratic Congress passed the Affordable Care Act early in the last decade, citing the cost to taxpayers.

Gov. Brian Kemp steered a limited Medicaid expansion through the legislature that took effect a year ago this month offering coverage to those with incomes up to 100% of the poverty level. However, far fewer Georgians than anticipated have enrolled in the program.

Republicans have pledged to consider a more robust Medicaid expansion when a state commission created this year to examine how Georgia can improve health-care access begins holding hearings.

But Kemp remains adamant that a full expansion of Medicaid will not happen on his watch. Georgia is among 10 states that have yet to expand Medicaid coverage through the Affordable Care Act.

Four other Senate Democrats are co-sponsoring Warnock’s bill, including Georgia Sen. Jon Ossoff.

Capitol Beat is a nonprofit news service operated by the Georgia Press Educational Foundation that provides coverage of state government to newspapers throughout Georgia. For more information visit capitol-beat.org.

The Stark Contrast in U.S. Road Safety and Regulations Across States

Summary

• Illinois has the most dangerous roads, with a high fatality rate due to aging infrastructure, insufficient maintenance, and heavy traffic volumes.

• Massachusetts is the safest state, with effective traffic management, stringent safety regulations, and substantial infrastructure investments.

• A three-pronged approach of upgrading infrastructure, enhancing traffic management, and strengthening law enforcement holds the promise of significantly improving road safety.

As the summer travel season approaches, knowing which states have the most dangerous and safest roads can make all the difference in keeping you and your family safe.

The data here reveals the states with the best and worst road safety records. Crystal Voogd from 5 Star Car Title Loans explains the factors contributing to their status. 

Most Dangerous Roads: Illinois

Illinois tops the list of states with the most dangerous roads. 

With a population of 2.5 million, the state recorded 1,255 fatalities in 2023, translating to a fatality rate of approximately 49 per 100,000 people. 

Contributing Factors

Illinois, a state with a rich history and vibrant culture, is unfortunately marred by a less favorable statistic—it has the most dangerous roads. 

According to Voogd, the state’s aging infrastructure, including roads and bridges, is frontline in this, paired with insufficient maintenance.

Additionally, the state’s urban areas have a high population density, which translates into heavy traffic. Also, due to the state’s central location, multiple major highways and interstates with heavy vehicle flow traverse the state.

“Illinois needs to prioritize infrastructure improvements and enhanced traffic management to ensure the well-being of drivers,” says Voogd.

But Illinois isn’t the only state that needs urgent attention. Georgia, Wisconsin, Wyoming, and Mississippi all have high fatality rates due to reasons including aging infrastructures, freezing winters (in Wisconsin), mountainous terrain (in Wyoming), and lack of investment. 

Safest Roads State: Massachusetts 

On the other end of the spectrum, Massachusetts is the safest state, with a fatality rate of 4.98 per 100,000 people. 

Contributing Factors

Massachusetts has implemented successful strategies to manage traffic flow efficiently. It has stringent safety regulations, including strict enforcement of laws against drunk driving and speeding.

Additionally, the state has made substantial investments in infrastructure, ensuring well-maintained roads and bridges.

Other states with notable road safety records include Hawaii (6.53), Rhode Island (6.56), and New Jersey (6.61). Along with efficient traffic management measures in these states, Hawaii’s island structure and Rhode Island’s compact size limit traffic congestion in the first place.

A Three-Pronged Road Safety Improvement Approach

“The stark disparities in road safety across U.S. states underscore the critical need for targeted interventions,” explains Crystal.

A three-pronged approach can significantly improve road safety: 

1. Prioritize infrastructure upgrades like better roads and bridges.

2. Enhance traffic management through strategies that efficiently control flow.

3. Strengthen traffic law enforcement with stricter penalties for DUI and speeding.

“By learning from the successes of states like Massachusetts, it is possible to create safer roadways and protect the lives of drivers across the country,” concludes Crystal.