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Tennessee will depend on charitable care and safety net hospitals to treat uninsured residents who catch the novel coronavirus.

Hospitals making triage plans, preparing for uptick from rural counties

Gov. Bill Lee says the state’s response is “fluid” and could change depending on the severity of the outbreak as cases increase. What appears concrete, though, is health care service.

The state will provide access to care through its Department of Health, in addition to urging health care companies to cover treatment with no out-of-pocket costs to patients, while depending on its safety net hospitals to treat low-income Tennesseans.

“We’re putting in direct access to the health care safety net for those who are uninsured to make sure that anyone who feels that they have a potential exposure to this can be treated through our health care safety net at no cost to them if they’re uninsured. There are a number of ways that we can provide services to those who are exposed,” Lee said.

Two of the state’s safety net hospitals, Regional One Health in Memphis and Nashville General at Meharry in Nashville, are in the state’s most populated areas.

Yet, 20 rural counties in Tennessee have no hospital, and 17 of those have no emergency room, according to the Sycamore Institute.

Lee made the statement last week after declaring a state of emergency for dealing with COVID-19, enabling the state to draw down increased federal funding and to unlock rules for health care treatment such as allowing out-of-state physicians to provide care here and to set up temporary sites for coronavirus testing.

Health officials said they plan to use $10 million in federal funding for measures such as telemedicine and providing tests, a major concern as state and national health officials try to get a handle on the disease.

North Memphis officials seek state funding to help with COVID-19

While the nation had about 1,700 cases, Tennessee had 32 as of Saturday afternoon, most of them in Davidson and Williamson counties. Shelby County reported two confirmed cases.

COVID-19 in Tennessee
Infogram

In announcing a national emergency Friday, March 13, President Donald Trump said millions of coronavirus tests soon will be made available across the nation, including at drive-through locations in parking lots at Walmart, Target, CVS and other stores. The president is to release $50 billion to combat the coronavirus.

It is unclear whether uninsured Tennesseans would be able to take a test at one of the drive-throughs.

Morris: Fear of the virus competes with fear of not working

Department of Health Commissioner Lisa Piercey gave a similar response as the governor days earlier when asked how Tennessee will deal with treating the uninsured.

“We have multiple safety net providers across the state as well as multiple providers that take uninsured patients. This isn’t any different than them seeking care for any other condition without insurance,” Piercey said.

She noted “multiple mechanisms” are in place to offset the cost of charity care and uncompensated care in those facilities.

Even so, Tennessee Hospital Association Executive Director Wendy Long said steps will be taken to make sure hospitals aren’t overburdened by a potential viral spread, including delaying non-essential surgeries and discharging patients who are ready to leave.

Legislative Democrats, however, say that is an ineffective way to provide care to patients. They argue Tennessee could cut accept more than a billion dollars annually from the federal government to cover the uninsured and avert safety net expenses to other programs.

Early in the week, Democrats made yet another call for expanding Medicaid to treat the uninsured population caught in a gap between TennCare and the Affordable Care Act.

Yet Republican state Rep. Ron Travis of Dayton, after making an impassioned plea, declined to bring his Medicaid expansion bill to a vote, citing lack of support in the TennCare Subcommittee. Travis told a story about how his sister-in-law, who was uninsured, died in an emergency room at the age of 48 some 12 hours after passing out in the shower.

Memphis’ second COVID-19 case is hospital employee

“If she would’ve had insurance with a $25 co-pay, a $40 co-pay, instead of looking at that $3,500 (emergency room) bill, maybe she would have went, and her children would have a mother, her husband would have a wife, her parents would have a daughter, and I’d have a sister-in-law,” Travis said.

With that legislation going nowhere, Medicaid expansion appears to be dead for the year. But state Rep. Antonio Parkinson remains concerned about the state’s working poor.

“You have a huge population of uninsured,” he said, noting he has spoken with Shelby County hospital administrators about the looming problem.

Some of the uninsured will become infected and stay home because they can’t afford to go to a doctor, he said, while others with symptoms use emergency rooms as their primary care physician.

“We talked about the possible run on emergency rooms with these hospitals and the fact it’s not being paid for,” said Parkinson, a Memphis Democrat.

The Sycamore Institute’s Brian Straessle could not comment on whether Shelby and Davidson hospitals will have enough beds to handle an influx of patients because of the number of variables involved, mainly how much the virus spreads. A Regional One Health spokesman did not return a phone call seeking comment.

About 4.6% of Tennessee live in a county without a hospital, most of which don’t have an emergency room. The 20 counties without a hospital also tend to have a lower capacity for primary and mental health care.

“I think it all goes back to trying to spread out the time frame in which you’ve got critical cases and then maximizing the resources that you have to deal with them,” Straessle said.