6. While the nation remains focused on a complete overhaul of the health care system, several cogs within the existing networks need immediate fixes.
The Tennessee AIDS Drug Assistance Program began this month putting people on waiting lists because the program has reached enrollment capacity.
CoverKIDS and CoverTN are about to stop taking new enrollees Nov. 30. Medicare is set to cut reimbursements to doctors by 21 percent next year. And the Regional Medical Center at Memphis plans to close its emergency department in February.
“We got a perfect storm brewing here for people who are marginalized and without resources to become sicker, really sicker,” said Kim Daugherty, the executive director of Friends for Life, a nonprofit organization that assists people living with the HIV virus.
Most of these cutbacks are occurring or likely will happen regardless of what Congress does with health care reform. Even if Congress enacts legislation to expand health care coverage, the timeline for implementation is staggered.
Any impact the legislation will have on The MED is largely unknown, said Gene Holcomb, the chairman of the hospital’s board.
“We have not seen the promised land,” said Holcomb.
Wandering in the desert
The issue with CoverKids and CoverTN is state funding. The federal government matches every dollar Tennessee spends on CoverKids with three dollars, while CoverTN receives no federal support.
No more children can be signed up for CoverKids after Nov. 30. No more working uninsured people can sign up for CoverTN after Dec. 31.
“This is the first time we’ve done this,” said Joe Burchfield, public information officer for Cover Tennessee, a program Gov. Phil Bredesen launched in 2007.
The state has had to make cutbacks since the onslaught of the nation’s prolonged recession.
“What we have now is our current operating budget is about $20 million,” he said. “That will support roughly 23,000 members. We are going to be coming up on 23,000, we believe by the end of year. That has put us in this first-time situation of suspending enrollment for (an) unknown period of time.”
The program is not likely to open back up until the 23,000 number shrinks enough to allow new enrollees, Burchfield said.
Cover Tennessee’s other two programs, CoverRX, which helps with prescription drugs, and AcccessTN, which provides health insurance to people denied in the private market because of pre-existing conditions, can continue enrolling people, he said.
This is also the first time the state-sponsored HIV medication program has had to halt new enrollees.
“Here’s the ugly truth: Somebody will die before the next person gets on,” Daugherty said. “Somebody has got to drop out before somebody gets in.”
Process of elimination
Tennessee joined Kentucky, Missouri, Nebraska, South Dakota, Utah and Wyoming in putting people seeking HIV medication on a waiting list.
“It is incredibly devastating to a person who might be newly diagnosed with HIV and who has no health insurance or any means of acquiring health insurance or medication to fight this virus to be told that now they cannot have access to medication which will give them a greater quality of life and really prolong their life – even save their life,” Daugherty said.
The situation is a setback to efforts to halt the spread of the virus and will also end up increasing health care costs in the long run, she said. People who can’t get the medicine to suppress the virus will end up in hospitals with illnesses, such as pneumonia, that could have been prevented.
Knowing medicine is not available will discourage uninsured people from being tested, she said, resulting in more people with higher viral loads.
“Memphis and Shelby County are much more highly impacted than other areas of the state because of our rising number of people with HIV in our community,” Daugherty said.
Shelby County accounts for nearly 40 percent of the 14,000-plus HIV/AIDS cases statewide, according to reports.
Broke – needs fixing
Daugherty said she’s very worried about the possibility of The MED shutting its doors. The board for the county-owned hospital, which treats a disproportionate share of the uninsured, recently voted to shut down its emergency room Feb. 1 unless it can come up with $32 million in additional operating funding.
The move is intended to improve the patient-payer mix because the ER is a gateway for uninsured patients.
“The MED bears the brunt in our community of people who don’t have access to health care,” she said.
Holcomb said The MED needs funding to build a new, more efficient hospital. The funding needs to keep operating are more immediate, he said.
“We have not yet seen anything that we think is going to alleviate our financial concerns,” Holcomb said. “Some of the programs may abate some of the no-pay type patients, but at the same time may provide for under-reimbursement, less-than-cost reimbursement as we get from TennCare and other programs now.”
The MED is also closely watching the state.
“To the state financing, which is more imminent, again we continue to be inundated through various associations and the governor’s office and so on with discouraging news about state finances and the thing that may have to happen, particularly after July 1,” Holcomb said. “All of those things are not favorable. There are none that are favorable to The MED.
Clearly, as people’s benefits erode or as people are being removed from the rolls of TennCare or other programs, they find their way to us eventually. As reimbursements erode, that has a direct and immediate effect on us.”
The elderly and the disabled could have a tougher time finding health care providers if Medicare slashes payments to physicians. Congress may address the “doc fix” in health care reform legislation. However, if no legislation passes to stop the 21 percent cut, more physicians are likely to stop accepting new Medicare patients....