NASHVILLE — 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 Nashville General Hospital. The lone public safety-net hospital in a city with a booming health care industry, it has provided care to multitudes of poor and uninsured people throughout the pandemic and for more than 130 years.Now, the end of federal programs that paid for Covid care for the uninsured and helped stabilize hospital finances during the pandemic is threatening a new kind of crisis for people like Ms. Howard and the providers that care for them. Billions of dollars in aid not only guaranteed that uninsured Covid patients would not face medical bills during the pandemic but also offered a lifeline for financially stressed institutions like Nashville General that provide extensive uncompensated care for the poor.The infusion of aid is ending at a time when hospitalizations from Covid 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, the 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 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.As he prepared to clip an uninsured patient’s worsening fungal toenails, Dr. Andrew Pierre, the hospital’s podiatrist, said the range of unchecked problems had expanded in his practice: bunions, flat feet that need reconstructive surgery, a surge in diabetic wounds.ImageDr. Eric Neff said the pandemic had created an environment in which patients were afraid of visiting the hospital. Credit...William DeShazer for The New York TimesDr. 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. 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.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 By: Noah Weiland
Title: Loss of Pandemic Aid Stresses Hospitals That Treat the Uninsured
Sourced From: www.nytimes.com/2022/05/01/us/politics/covid-aid-hospitals-uninsured.html
Published Date: Sun, 01 May 2022 09:00:18 +0000
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