COVID-19 Is A Crisis, But Nashville’s Failure To Expand TennCare Could Make It A Disaster For Tennessee
On March 19, 2020, the number of confirmed COVID-19 cases in the state of Tennessee topped 150. As of this being published on March 21, the cases were at 371. This number is growing quickly and is expected to be underreported, as at least one study found that up to 86% of cases can go undetected. Combine that with the well-documented severe shortage of available tests in the United States and the fact that East Tennessee is showing an atypical spike in fevers, and Governor Bill Lee has a huge undertaking on his hands.
But Tennessee’s future could have been more certain during this time if lawmakers had taken action during the previous administration, when Governor Bill Haslam set his sights on expanding Medicaid in the state. Even as a Republican governor with a supermajority of Republican state lawmakers, the initiative was rejected. As a result, Tennessee will have missed out on a total of $22.5 billion in federal funding between 2013 and 2022, while Tennesseans pay $7.8 billion in federal taxes to fund health care costs in states that have chosen to expand Medicaid.
Imagine what this influx of funding could have done to save the 12 rural hospitals in Tennessee that have closed since 2012 or the additional 15 that are losing money and at risk of collapse. These hospitals would have been on the forefront of stemming the rapid spread of the deadly COVID-19 virus throughout the state.
As COVID-19 spreads and disproportionately endangers the health of those aged 60+ and the immunocompromised population, our health care system will increasingly rely on ventilators and other sophisticated equipment to keep patients alive in Intensive Care Units (ICUs). Unfortunately, only about half of Tennessee’s 95 counties have ICU beds, with the vast majority located in Davidson, Shelby, and Knox Counties. With approximately 20% of Tennessee’s population over the age of 60, these ICU beds are going to be more important than ever before. Unfortunately, those who live in counties with no or few ICU beds will likely have to travel to an adjacent county for life-saving treatment. But a significant influx of patients could overwhelm even our largest health care networks in Nashville, Memphis, and Knoxville, risking the future of Tennessee’s entire health care system. This doesn’t even take into account the number of patients who relied on ventilators and ICU beds prior to the COVID-19 outbreak.
An influx of $22.5 billion over 10 years could have prevented 12 rural hospital closures and relieved the economic turmoil of 15 more. It could have saved 535 total hospital beds, purchased ventilators, and expanded ICU care. It could have been used to expand telehealth services to prevent hospitals from being flooded by non-life-threatening cases, as Ohio did.
It was a good time to expand Medicaid in Tennessee six years ago. It is a good time to expand it now. The legislature could have taken Medicaid expansion funds, before the legislature recessed for the next two months. It did not. Now, we are all left to wonder what kind of damage our lawmakers will return to when they come back to session?
Tony Hanna is a native Tennessean and former campaign associate at the progressive Center for American Progress.
