Rural hospitals threatened by possible funding cuts

Sunday, July 16, 2017

Editor’s Note: This is part of an ongoing series on poverty in Bedford County. Read the entire series online at

Experts involved in health care for the poor say Congress’ efforts to overhaul the Affordable Care Act and Medicaid could affect rural hospitals like Shelbyville’s.


The U.S. Senate’s proposed overhaul, titled the Better Care Reconciliation Act, could threaten the future of Tennova Healthcare-Shelbyville hospital, said Kinika Young, director of children’s health for Tennessee Justice Center.

The health care advocacy group created a list of hospitals it considers to be at-risk based on joint annual reports that hospitals file with the state. TJC “determined that hospitals that have lost money on average over the 3-year period reviewed are at risk of closing if a main stream of revenue (Medicaid payments) is reduced,” she said.

Tennova expresses concern


A Tennova executive said the hospital provides millions in charity care and is concerned about the health care debate.

“Though the future of the Senate bill remains unclear, Tennova Healthcare-Shelbyville, like hospitals across the country, is concerned about the potential impact reductions in Medicaid funding would have on our most vulnerable citizens,” said Charisse Parker, Tennova human relations and marketing director. “We remain hopeful that our elected officials will keep the wellbeing of the most vulnerable members of our citizenry in mind.”

Corker: Not a cut


A spokeswoman from Corker’s office disputes claims the pending legislation would cut Medicaid funding. Rather, the Senate would cut the rate of growth. And some of the TJC’s concerns were based from a draft released last month that is not being voted on, spokeswoman Micah Johnson said. The discussion draft says the bill would guarantee children with medically complex disabilities will continue to be covered.

“Under the discussion draft, the rate of Medicaid funding increases every year,” Johnson said. “There is no cut but rather a slowing in the growth of the federal contribution. With the federal government currently $20 trillion in debt and mandatory spending programs accounting for 70 percent of spending, the senator supports the idea of giving governors the flexibility they have been requesting for decades while over time creating a more appropriate partnership between states and the federal government.”

Plan updated

Senate Republicans introduced an updated bill Thursday, The Associated Press reports. Among other measures, the bill would allow insurers to sell low-cost policies. It keeps language to phase out extra money that 31 states used to expand Medicaid under the ACA and limit future growth. Since its creation in 1965, the Medicaid program has provided open-ended federal funds to help states pay the program’s costs.

In 2021, the Senate’s plan would begin gradual reductions in the amount of federal Obamacare funds provided to expand Medicaid.

“Senator Corker has consistently advocated for refundable premium tax credits that ensure low- and-middle income Americans have the ability to purchase health insurance that they can actually use,” Johnson said. “The draft Senate language does extend the refundable premium tax credits to people who are at 0-100 percent of poverty but currently receive no premium assistance in non-Medicaid expansion states.”

Corker said in a statement, “As we debate the bill next week, every senator — on both sides of the aisle — will have the opportunity to offer amendments and have their voice heard. I am encouraged by the direction of the bill and am hopeful the final product will be one that works better for the American people than what is in place today.” Corker will support the motion to proceed to the legislation this week.

High stakes

Any potential changes to Medicaid raise high stakes.

Tennessee is a national leader in the closure of rural hospitals, Young said, citing research by Becker’s Hospital Review. There are 108 general medical and surgical hospitals in the state, including 32 that would be at risk of major cuts or closures. Changes to Medicaid could leave 23 Tennessee counties, including Bedford, without a hospital and affect the economy through 13,000 lost jobs, she said.

Shelbyville’s hospital employs more than 250, including 183 medical staff, Parker said. In 2016, Tennova provided more than $6 million in charity and uncompensated care. Nearly 21 percent of its patients are covered by Medicaid (TennCare).

“Our financial counselors work with uninsured patients to help them determine if they qualify for the program or other coverage so they can secure ongoing care,” Parker said. Tennova continues to add services and physicians.

“We strive to be a sustainable organization for the long term and continually review the services we offer in response to changing demographics,” Parker said. “Surgery has been a growing need, so we recruited a new orthopedic surgeon last year and made investments in physical therapy and surgical equipment to support increased numbers of patients.”


$6 million plus: Amount of charity and uncompensated care provided by Tennova in 2016

250: Number of local Tennova employees

21: Percentage of Tennova patients covered by Medicaid

43: Percentage of Bedford County children receiving government insurance

1.5 million: Number of Tennesseans on TennCare

Sources: Tennova Healthcare-Shelbyville, Tennessee Justice Center


Senate bill:

List of at-risk hospitals with online version of this story

Tennessee Justice Center:

Sen. Bob Corker’s office:

Tennova Healthcare-Shelbyville:

Related links