Rural counties like Fentress hard hit when TennCare cuts rolls
“There is no way I can pay for my medicines. No way,” said Shields, a 36-year-old long-haul trucker who can no longer drive professionally because of a debilitating combination of chronic pain and shortness of breath, high blood pressure, allergies and diabetes.
Shields fears he is going to lose his health insurance from TennCare, Tennessee’s expanded Medicaid program for the poor, uninsured and uninsurable, because of state budget cuts.
“If the cuts go through like they are being proposed, it’s pretty much like the governor is saying, ‘Which disease do you want to die from?'” said Shields, who faces drug bills far exceeding the $1,600 he receives in Social Security each month to support himself, his wife and two children.
Shields’ problem is shared by others in this rural county near the Kentucky line, where the rolling landscape is beautiful and the jobs are scarce. Nearly one of every two people in this county of 17,023 is on TennCare — the highest percentage in the state.
As many as 2,876 Fentress adults, including Shields, are among tens of thousands statewide set to be dropped from TennCare in coming weeks, pending a last-minute funding bailout and court appeals.
“Nobody knows what the final picture is,” said County Mayor John Mullinix, who seeks comfort in the Bible on his desk. “But it will have a tremendous impact on this county.”
Tennessee Gov. Phil Bredesen originally announced plans to cut 323,000 adults from TennCare, but he recently agreed to limit the cuts to only about 225,000 people.
TennCare covers about 1.3 million people — or nearly 23 percent of the state’s population. When it was created in 1994, it was considered a national model because it was more generous than most expanded Medicaid programs.
But the state is now struggling to control a program that would consume 91 percent of new state revenues if left unchecked, according to an independent 2004 report.
“I think everybody concerned is going to have to make some sacrifices. Everybody,” Mullinix said, wondering if the county’s eight or nine doctors would be able to stay in business.
Dr. Leonard Carroll, a general surgeon who has practiced in Jamestown for 17 years, knows the problem first hand. Seventy percent of his patients are TennCare recipients.
“We will do what we did in the days before TennCare. They (patients) will present, and they will have no money or means to pay and they will be taken care of for free,” said Carroll, who already treats about one in 10 patients at no charge.
Carroll said that’s to be expected in such a poor county, where a quarter of the residents live below the poverty line and the median family income is $28,856 — about half the national average, according to the U.S. Census.
“It makes it difficult. But, hey, I don’t have any other place to go. I love this area,” he said.
“The panic in town is that we are going to close,” said Dwayne Blaylock, chief executive officer at Jamestown Regional Medical Center. “But we can’t close. We are the sole community hospital. So we are just going to be scrambling to provide the care.”
The 85-bed for-profit facility, formerly Fentress County General Hospital, is also one of the largest employers with about 300 people on the payroll. About 35 percent of its business is TennCare patients.
“I know in a lot of communities they fear a dumping of patients from physicians onto the hospital. I am hopeful that won’t happen here,” said Blaylock, who will try to save the hospital by luring paying patients who now travel to Crossville, Cookeville, Knoxville or Nashville for care.
Terry Shields can’t explain why nearly a third of all working-age adults in Fentress County are considered disabled. All he knows is that he wants to work but can’t.
“There are people who go for the easy way out. There are people who do that,” Shields said. “But there are people who are really sick. There are people who really deserve to be on disability. And without TennCare, I don’t see how they will survive.”