Tennessee Health-Care Cuts Roil Poor Community Last year, Tennessee dropped some 200,000 people from TennCare, its health plan for the poor and uninsured, and reduced benefits for hundreds of thousands more. In Cocke County, one of the state's poorest, the repercussions are felt far and wide.

Tennessee Health-Care Cuts Roil Poor Community

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It's MORNING EDITION from NPR News. Renee Montagne is away. I'm Steve Inskeep.

This morning, we'll visit one of many places struggling to contain the climbing cost of healthcare. The town is in Tennessee. Last year, the state dropped some 200,000 people from its TennCare program. That's the healthcare plan that replaced Medicaid. Tennessee also reduced benefits for hundreds of thousands of people.

NPR's Julie Rovner found out what those numbers mean to the town of Newport in one of the state's poorest counties.

Dr. CONSTANTINO DIAZ-MIRANDA (Chief of Staff and Medical Director of Emergency Services, Baptist Hospital of Cocke County, Tennessee): Hi...

JULIE ROVNER reporting:

It's a little before 8:00 a.m. in the gleaming new emergency room at Baptist Hospital of Cocke County.

Dr. DIAZ-MIRANDA: My goodness gracious! I'm Dr. Diaz, what's going on with you?

ROVNER: Dr. Constantino Diaz-Miranda is seeing his first patient of the day, Ruth Evelyn Wailey(ph).

Dr. DIAZ-MIRANDA: What was the reason that you don't get your medicines, you saying?

Unidentified Woman: Huh?

Dr. DIAZ-MIRANDA: Why was the reason that you do not get your medicines?

Unidentified Woman: Well, because I didn't have no money to pay for it.


ROVNER: It's become an increasingly common storyline in this part of the state. By some accounts, as much as 40 percent of Cocke County residents were on TennCare before the cuts. Patients lose their insurance, try to get by without care until they simply can't get wait any longer.

Dr. DIAZ-MIRANDA: I have had patients that they were quite sick because their insurance was not in effect any longer. And they do not have the ability to buy the medicines.

ROVNER: Dr. Diaz, as he calls himself, moved to eastern Tennessee from Spain two decades ago and never left. He says when the TennCare cuts happened, many expected an immediate surge in uninsured patients showing up in the ER. That didn't happen. Instead, the growth has been more insidious.

Dr. DIAZ-MIRANDA: It's happening slowly. We have seen the effects of it in here at Cocke County. I've been here long enough that, you know, I have lots of recurring patients. They come to the emergency department. And I know that that in the past, they have had TennCare. Today they are listed as private pay, in other words, no insured. You know, little by little, it's happening, and it's getting worse.

ROVNER: He says some of the patients show up at the hospital because without insurance, they can't afford to see their primary care doctors anymore.

Dr. DIAZ-MIRANDA: They have to come up with 25, $50 or whatever that office will charge them to be seen. We see quite a few of those.

ROVNER: In other cases, patients with chronic ailments simply try to do without until they actually do need emergency care. Diaz says one woman with diabetes who'd lost her insurance was a repeat visitor.

Dr. DIAZ-MIRANDA: When I saw her, it was her third visit to the emergency department with blood sugars in the six and 700 range.

ROVNER: Which is dangerously high. In the end, he simply dug into his own pocket to get her what she needed.

Dr. DIAZ-MIRANDA: If she went back to the house without any insulin, she would have come back, you know, the next day or whatever. So we bought her the insulin and we got somebody who was going to draw the insulin from the bottle so she will be getting the right dose.

ROVNER: How long can you go on like this? Is it getting to a point where the whole thing falls apart?

Dr. DIAZ-MIRANDA: We are not there yet, but I believe that if this continues this way, we will get there, unless the state comes up with some sort of program where they can help those patients that they don't have no insurance.

ROVNER: The increase in uninsured patients is a big worry for hospital administrator Jim Decker. Just two years ago, the hospital spent millions of dollars to expand this emergency department from seven to 17 beds. But it's not clear how the hospital can pay its bills if its patients can't pay theirs. And he says that could cause a ripple effect of its own.

Mr. JIM DECKER (Administrator, Baptist Hospital of Cocke County, Tennessee): Quite often, the hospital is one of the foundations, the institutions of any community. And that's true, certainly here. We're one of the largest employers. It's an important component of this community and one in which we're striving very much to maintain.

(Soundbite of food pantry)

ROVNER: Across the street from the hospital and around a winding gravel driveway is the local food pantry.

Ms. LINDA OWENS(ph) (Volunteer, Bread Basket): The name of this place is the Bread Basket. They give out food to the people in the community on Monday, Wednesday and Friday.

ROVNER: Linda Owens is one of many volunteers at the Bread Basket who's also been a recipient here. She said she's seen demand for not just food, but for other services pick up since last year's TennCare cuts.

Ms. OWENS: People are having to choose between do they buy food or do they buy medicine. That, of course, affects us in many ways. It increases our theft rate, because people are having to survive. If you know you don't have a drug that's going to keep you alive, then that puts your family in a position that they're having to make choices they shouldn't have to make. Some have chose to sell their food stamps, of course, which is illegal. But they've had to do it to get the medicine that's going to keep them alive.

ROVNER: Phil Ruck(ph) oversees Operation Get the Bread Basket. He carries a tally book that shows how demand has spiked since last year's TennCare cuts. He says he's not at all surprised.

Mr. PHIL RUCK (Operation Get the Bread Basket): We have a sign that we take to fairs that describes the cycle of poverty. One of the elements of the cycle of poverty is poor healthcare, because folks do not have the access to the medical care that they need. Because of that they also get sick. As they get sick they can't hold a job, and so all of that impacts the total picture.

ROVNER: And it's not just charities feeling the impact. Local businesses have been affected by the TennCare cuts as well.

(Soundbite of train)

ROVNER: Down the hill from the hospital, just across from the railroad tracks is...

Mr. MARTY BAILEY(ph) (Owner and Pharmacist, Wilson Save More Pharmacy): Wilson Save More Pharmacy.

ROVNER: Marty Bailey is the owner and pharmacist.

Mr. BAILEY: I've been at this drugstore 23 years. I know these people very well. I know nearly everybody that walks in here, which means I know most everybody in Cocke County.

ROVNER: In fact, many of them are featured in dozens of pictures that completely cover one wall and stretch around to two others.

Mr. BAILEY: These are our customers, and they enjoy coming to see their pictures on the wall. Or their dog. We have dogs here.

ROVNER: But business hasn't been so good since the TennCare cuts.

Mr. BAILEY: We had to lose 20 to 30 percent of our business when TennCare changed. We had to cut down dramatically on our prescription buying. We have had to cut back on the hours of our employees, because you don't know if you're going to be able to pay the bills next month.

ROVNER: You hear a similar story just up the street at JayBo's(ph) Pharmacy. In front is an old fashioned soda fountain. It's crowded with workers from the ConAgra canned food factory next door, many still wearing their hairnets.

(Soundbite of people talking)

ROVNER: But the '50s era front of the store contrasts dramatically with the scene behind Jay Bo's Pharmacy counter. There busy clerks stand in front of computer monitors while a huge counting machine sorts pills and spits them out neatly in bottles.

Jeremy Sharrod(ph) is one of the pharmacists. He says the last few months have been particularly difficult, especially for the TennCare patients who've had to cut back on their prescriptions.

Mr. JEREMY SHARROD (Pharmacist): You know, it's hard to tell them (unintelligible) diabetes or the congestive heart failure, which one are they going to die the quickest if they don't take their medication? It's like we're making a decision of life and death, in a sense, and we're not meant to do that.

ROVNER: Sharrod says he worries most about the people who come from some of the more remote areas in the foothills of the great Smokey Mountains. He says when they encounter problems at the pharmacy counter they are as likely as not just to go home.

Mr. SHARROD: Obviously, in a rural community, where there's less education, less jobs available, where the people are less aggressive to fight for their rights, it's going to make a larger impact than it would in a more suburban area. I mean it's just, the people will just accept it and say, hey, we can't get it, we'll go on without it. If we live we live, if we die we die.

ROVNER: Just last week, Tennessee Governor Phil Bredesen signed into a law a new program that would subsidize private insurance for low income working families. But most of those who were dropped from TennCare last year won't be eligible, and it's not yet clear how much the new program will help boost the fortunes of the people of Cocke County.

Julie Rovner, NPR News.

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