Ending of Federal Pandemic Aid Stresses Hospitals That Treat the Uninsured

Loss of Pandemic Aid Stresses Hospitals That Treat the Uninsured NASHVILLE, Tenn. — Mary Howard, a dishwasher with no health insurance, has never had COVID-19. But the coronavirus, she said, caused her life to spiral over the past two years. Friends died from it. Ordinary parts of her day, like riding the bus, felt perilous. The restaurant where she worked closed temporarily, and she fought depression and high blood pressure, seeking care in the emergency room because in-person appointments were hard to come by as the pandemic raged. She turned for help to Na YahooNews

...the infusion of aid is ending at a time when hospitalizations from COVID-19 are receding but as safety-net providers are facing tremendous unmet needs from patients who have delayed care for chronic conditions and other health problems even more than usual during the pandemic.

“Their margins are slim to begin with,” Beth Feldpush, senior vice president for policy and advocacy at America’s Essential Hospitals, which represents safety-net hospitals, said of the institutions. She added that some were already having a “more difficult time bouncing back operationally and financially.”

Nashville General has seen an average of just one COVID-19 patient a week recently. But its doctors and nurses say that a wide range of health problems that worsened during the pandemic are now overwhelming the hospital. ...y, a surge in diabetic wounds.

Dr. Eric Neff, an orthopedic surgeon, said patients were afraid to visit the hospital during much of the pandemic and often had trouble finding transportation when they did. The consequences were dire: People waited six months to seek care for a broken wrist or ignored a torn rotator cuff, making it harder for him to fix their injuries.

“It’s horrible,” he said.

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. 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.

Dr. Richard Fremont, a pulmonologist, said that he had treated dozens of COVID-19 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-19. Now, he said, hospitals and patients are back to facing pre-pandemic pressures — and will face even more once the federal government ends the public health emergency, which has temporarily increased Medicaid and Medicare reimbursements.

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