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More than $ 3 billion in federal money has flocked to Texas health care providers in recent months to help pay for COVID-19 treatments, tests and vaccines for patients without health insurance, according to national health authorities.
Of that, a small portion – about $ 2.2 million – went to the local independent hospital in Titus County in the countryside to treat patients under wave after overwhelming wave of the devastating virus in an area where 1 in 3 residents is uninsured.
But the 174-bed Titus Regional Medical Center in Northeast Texas needed every penny it could get as it struggled to cover the sudden pandemic, skyrocketing expenses: paying staff competitive salaries to keep them on the job, complying with federal security rules and deal with a record number of patients flowing into the intensive care unit from a radius of 150 miles, said CEO Terry Scoggin.
Now, after sending about $ 19 billion to hospitals and other healthcare providers nationwide, the fund is known as the Health Resources and Services Administration COVID-19 uninsured program – set up to help hospitals like Titus Regional pay for the care of uninsured COVID patients – has dried up.
While stopping funds comes as Texas has seen infection rates fall dramaticallythe virus is still largely uncontrolled, causing increases and closures in other countries. In the past, these increases abroad have always taken place before new cases reappear here in the United States, including Texas, which has more uninsured residents than any other state.
That failure to renew the program in time to continue reimbursing providers means that hospitals, clinics, private practices and others that do not receive public health funding from the state will have to “eat the cost” if they do not charge for COVID-related services, said Scoggin.
“It’s a big problem for us because we have so many adults who are uninsured,” Scoggin said. “And so it was a kind of kick in the stomach for us when they closed that program because I thought it was a good use of funds for the COVID piece.”
Denying care to those patients who cannot pay is not an option, either legally or morally, he said.
“We can not reject people, so we’re still going to pay for it,” Scoggin said. “It just shifted the cost of the uninsured from federal funds to individual hospitals.”
Throughout the pandemic, the federal government has spent tax dollars on reduce the cost of COVID control on government and healthcare providers.
Much of this assistance has come through direct procurement of tests, vaccines and treatments, which are then distributed to providers at no cost to them, enabling them to provide care at no cost to the public while still being able to cover their operating budgets. during attack by patients.
It also comes in the form of HRSA reimbursements to government providers to cover part of the cost of treating uninsured COVID patients as well as administering tests and vaccines.
In Texas, providers have received about $ 1.8 billion for the treatment of uninsured COVID-19 patients, according to US Centers for Disease Control and Prevention.
Texas has the country’s lowest insurance coverage rate and is one of 11 states that have chosen not to expand Medicaid coverage to include more adults living in poverty. The percentage of Texans covered by the public insurance program is a little over half the national average.
The cost of treating a COVID-19 patient far exceeds the cost of the actual therapy, with so-called “wrap-around infection control” measures that include isolation wings inside a facility and personal protective equipment such as masks, as well as other costs.
Recent Studies have shown that the average cost of treating one COVID patient on an outpatient basis is more than $ 1,200. Put the patient in a ventilator in the intensive care unit and the price can go up to $ 300,000.
In March, just weeks after hospitals saw a record number of people hospitalized with COVID-19 in Texas and other states, the U.S. Centers for Medicaid and Medicare Services announced that claims for uninsured patients being treated or tested for coronavirus would no longer be accepted and that previous claims would be filled as funds became available.
In April, uninsured vaccines were also excluded from reimbursement, and the federal government has said that no more money after the current supply of tests, treatments, and vaccines expires if Congress does not act.
An attempt by the White House to add billions to the program has fallen victim to Washington’s political arguments over the use of tax dollars to respond to the pandemic.
Health experts say the impact could include fewer independent or private providers offering some of the services they could have previously been reimbursed for, which could reduce access to care in underserved areas. And that may mean that these providers are no longer willing or able to take on overflows from safety net hospitals in the event of a new increase.
It puts pressure on educational hospitals and rural providers like Titus Regional, which offer these treatments regardless of ability to pay.
“Regardless of how providers respond, the result is likely to be reduced access for uninsured patients in most states due to more limited provider access and / or potential cost costs,” Kaiser Health researchers said in a recent analysis of the advertisement.
The halt to the program suggests U.S. lawmakers are ready to shift responsibility for pandemic response back to states and local providers – even as hospital officials and national health officials warn of the continued toll the pandemic is taking, declining vaccine efficacy, new variants and the potential for a fall wave in case of infections.
“The funding was great, but came far from the need,” said Carrie Williams, a spokeswoman for the Texas Hospital Association. “The impact of the pandemic is far from over for hospitals. We are left with staff shortages and soaring labor and delivery costs. We are vulnerable, especially if there is a new increase.”
The death of the COVID-19 subsidy program, if it remains dead, is a clear indicator that those responsible for the money do not understand that the pandemic battle continues for health care providers, advocates say.
“Hospitals that provide significant community health services have disproportionately treated uninsured COVID patients during previous waves of the virus and will be at the forefront, not only of any fremtid future increases in cases and hospitalizations, but also community tests, as most communities have shut down their test sites, “read a recent statement from Texas Hospitals of Texas, urging Congress to fund the program again.
Right now, there has not been a patient admitted to Titus Regional with COVID in a week, Scoggin said.
But the majority of the residents of Titus and the surrounding counties are still not fully vaccinated. Only a small percentage have booster shots. The number of new cases is still low, but they have begun cross up, a little.
The idea that an uninsured local resident could get COVID-19, end up on a ventilator and demand treatment worth $ 100,000 they can’t pay for is not an unlikely scenario, Scoggin said.
And while uncompensated care reimbursements to providers are still available through other funding flows, as they have been for years, the addition of COVID-19 to the mix simply means more competition for fewer dollars to help pay for a particularly expensive disease, he said. .
“We have taken care of our community through COVID and we will continue to do so, but this is just another unfunded mandate from the federal government,” Scoggin said. “It’s just a question of how many of these mandates you can handle? That is the difficult part. “
Disclosure: The Texas Hospital Association has provided financial support to The Texas Tribune, a nonprofit, non-partisan news organization funded in part by donations from members, foundations, and corporate sponsors. Financial support does not play a role in Tribune’s journalism. Find a complete list them here.
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