In past issues of The Pacer, we have highlighted the shortage of hospitals and emergency medical services in several rural West Tennessee counties.
In addition to Haywood, McKenzie and McNairy counties no longer having such services, a recent closure of a medical center in Humbolt dating back to Oct. 25 has left Gibson County with only one emergency room.
With medical centers closing down all over West Tennessee, elected representatives from the affected districts have been putting legislation into motion to affect a solution in our area and in similar regions across the country.
According to recent reporting by The Jackson Sun, the representative of the Tennessee 8th Congressional District, Congressman David Kustoff (R), would be co-sponsoring two bills that dealt with rural healthcare in particular – the Rural Health Innovation Act and the Rural America Health Corps Act.
It was left unclear in the Sun’s reporting how Kustoff’s efforts related to Senator Marsha Blackburn’s (R-TN) two bills of the same name that were both introduced to the Senate on July 31 and referred to the Committee on Health, Education, Labor and Pensions.
It seems reasonable to suggest, however, that both of Senator Blackburn’s bills will eventually be introduced again to the House. The Rural America Health Corps Act, filed under Senate Bill 2406 in July, was rereleased Oct. 29 as House Bill 4899 and is unchanged from its Senate counterpart. The new House bill was referred to the Committee on Energy and Commerce.
The Rural America Health Corps Act, according to a press release by the bill’s co-sponsor Rep. Phil Roe (R-TN), would create a new program to encourage doctors and nurses to find work in underserved areas. It would create a sliding-scale system of student loan repayment, with more funding going to medical professionals who choose to work in more severely underserved communities. It also waives the income tax liability for those participating in the program.
If the Rural Health Innovation Act also goes to the House unchanged from its Senate counterpart, it would create a grant program under which rural health centers and medical practitioners eligible for Federal funding would be able to apply for Federal funds under the Rural Health Center Innovation Awards Program.
The stated purpose of the funding is to expand the hours of operation for clinics and medical centers, pay for construction and renovation, or for other maintenance. The grant amount is capped, however, at $500,000 annually.
Both bills have bipartisan support from Democratic representatives, but the fact that Blackburn’s identical Senate bills were stymied in committee does not bode well for either piece of legislation.
An important caveat to keep in mind with these bills is that they don’t touch on patient insurance in any capacity. This is not necessarily a shortcoming of the bills, as any piece of legislation can only do so much, but could be a roadblock to wider bipartisan support.
Democratic lawmakers have made expanding access to health insurance the principle healthcare issue in this and previous election cycles. Bills that would, at most, put a bandaid on a problem that is of negligible impact in terms of per capita investment would seem to distract from wider issues surrounding affordability of actually using those health services.
Furthermore, rural areas like West Tennessee are heavily Republican districts. Increasing funding for rural health doesn’t constitute worthwhile pork barrel spending for most Democratic lawmakers from highly urban or suburban districts – most of which have well-functioning emergency medical services, and so are more concerned with the affordability question.
Plus, provisions like loan forgiveness under the Health Corps Act would constitute financial relief for workers in relatively well-paying fields. Despite the high costs of attending medical school or medical certification training, creating loan forgiveness programs for what are percieved to be high paying positions might not go over well with Democratic politicians more focused on poor relief.
Even with the question of whether the bills will pass aside, it’s not clear that they would actually do much to allieve the situation in West Tennessee. How many doctors and RNs, for example, could the Health Corps loan forgiveness program actually support? And would it be enough to make up for the staff moving to more populated areas for higher pay?
People who live and practice medicine in rural communities must have a real attachment to the area and its people. Money alone is not an effective motivator, given that there will always be better paying positions somewhere else, especially as health care grows as an industry.
On top of that, the grant funding offered by the Innovation Awards Program may not be sufficient to tackle the problems these hospitals are facing. When McNairy Regional closed down in my home county, they cited extensive repairs that would need to be done to the plumbing and sewer systems. When inspectors told them that repairs would take six months or more, they closed down the hospital permanently.
One of the factors they cited, in addition to the cost of replacing the aging water infrastructure, was the sharp decline in patients over the years.
This trend, likely more than anything else, is killing our small regional hospitals quicker than aging facilities. Health care companies like Tennova cannot continue to operate facilities in areas where they, as a for-profit company, can’t make any money. Insurance and the lack thereof plays into the problem, but more than anything else this is a function of population density.
When we put the problem of rural health care in this wider socioeconomic context, it is easier to see how recent legislation, if it ever crawls out of committee, is merely a weak attempt to solve the region’s problems.
Fundamentally, West Tennessee needs a new model of medical care that is tailored for the scale of their communities and the unique disadvantages that they face, with lack of transportation infrastructure and a population spread thinly over a large area being high on that list.
But I wouldn’t hold my breath, either for private companies or for enterprising politicians to put a foot in the direction of actually solving West Tennessee’s health care woes.
Photo Credit / University Relations
