Loss of Pandemic Aid Stresses Hospitals That Treat the Uninsured

Dr. Philip Elizondo, his orthopedic colleague, said the hospital had to cancel minor surgeries for health problems that subsequently ballooned. One uninsured woman he treated had torn her meniscus, lost her job and lost her house.

Dr. Elizondo said he could have performed a 20-minute surgery if the patient had been able to seek care immediately, but instead her injury went untreated and got worse.

“It’s horrible,” he said.

Dr. Richard Fremont, a pulmonologist, said that he had treated dozens of Covid patients over the past two years, but that patients with other health conditions, such as chronic asthma, had more often needed oxygen. Because uninsured patients cannot get short-term home oxygen therapy, he sometimes keeps those who need it in the hospital for days or weeks.

The crisis of the uninsured is especially acute in Tennessee, which has one of the highest rates of hospital closures in the country and is among a dozen states that have chosen not to expand Medicaid to cover more low-income adults under the Affordable Care Act. Roughly 300,000 people in the state fall in the so-called coverage gap, meaning they are ineligible for either Medicaid or discounted health insurance under the Affordable Care Act despite having little to no income.

John Graves, a health policy professor at Vanderbilt University School of Medicine, said the influx of relief funds during the pandemic had allowed something akin to a “universal coverage system within a system,” granting coverage to everyone who got Covid. Now, he said, hospitals and patients are back to facing prepandemic pressures — and will face even more once the federal government ends the public health emergency, which has temporarily increased Medicaid and Medicare reimbursements.

The federal Provider Relief Fund offered hospitals an early lifeline in the pandemic by providing tens of billions in direct funding, although the money was steered inequitably, said Jason Buxbaum, a Harvard doctoral student who has written about the program.

Separately, the Covid-19 Uninsured Program provided more than $20 billion in reimbursements to roughly 50,000 hospitals, clinics and other providers for testing, vaccinating and treating the uninsured, including nearly $8 million to Nashville General. A pandemic relief package that has stalled in the Senate will most likely not replenish the fund, leaving providers on the hook and making reimbursements during future Covid waves unlikely.

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