As federal funds dry up, Texas hospitals pick up COVID-19 tab Texas hospitals prepare to pick up the tab for uninsured COVID-19 patients as federal funds dry up

More than $3 billion in federal money has flowed 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 officials.

Of that, a tiny fraction - some $2.2 million - went to the local independent hospital in rural Titus County for treating patients during wave after overwhelming wave of the devastating virus in an area where 1 in 3 residents are 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, skyrocketing expenses of the pandemic: paying staff competitive wages to keep them on the job, keeping up with federal safety rules and managing record-breaking numbers of patients pouring into in the intensive care unit from a 150-mile radius, said CEO Terry Scoggin.

Now, after sending some $19 billion to hospitals and other health care providers nationwide, the fund known as the Health Resources and Services Administration COVID-19 Uninsured Program - created to help hospitals like Titus Regional pay for the care of uninsured COVID-19 patients - has dried up.

While the halting of funds comes as Texas has seen infection numbers fall dramatically, the virus is still largely uncontrolled, causing surges and lockdowns in other countries. In the past, those surges abroad have always occurred before new cases rise again here in the United States, including Texas, which has more uninsured residents than any other state.

The failure to renew the program in time to continue reimbursing providers means that hospitals, clinics, private practices and others that don't get public health funding from the state will have to "eat the cost" if they don't charge for COVID-19-related services, Scoggin said.

"It's a huge issue for us because we have so many adults who are uninsured," Scoggin said. "And so it was kind of a kick in the gut for us when they shut that program off because I thought it was a good use of funds for the COVID piece."

Refusing care to those patients who can't pay is not an option, legally or morally, he said.

"We can't turn people away, so we're still going to pay for it," Scoggin said. "It just shifted the expense of the uninsured from federal funds to individual hospitals."

Throughout the pandemic, the federal government has used tax dollars to alleviate the cost of COVID-19 response on government and health care providers.

Much of that assistance has come through the direct purchasing of tests, vaccines and treatments that are then distributed to providers at no cost to them, allowing them to provide care at no cost to the public while still being able to cover their operating budgets during the onslaught of patients.

It's also come in the form of the HRSA reimbursements to state providers to cover a portion of the cost of treating uninsured COVID-19 patients, as well as administering tests and vaccines.

In Texas, providers have received some $1.8 billion for the treatment of uninsured COVID-19 patients, according to the U.S. Centers for Disease Control and Prevention.

Texas has the nation's lowest rate of insurance coverage 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 that government insurance program is just over half the national average.

The cost of treating a COVID-19 patient goes far beyond 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 like masks, as well as other costs.

Recent studies have shown that the cost of treating one COVID-19 patient on an outpatient basis averages more than $1,200. Put that patient on a ventilator in the ICU, and the cost can go up to $300,000.

The halting of the program hints that U.S. lawmakers are ready to shift the responsibility for pandemic response back to the states and local providers - even as hospital officials and national health leaders warn of the continuing toll the pandemic is taking, waning vaccine efficacy, new variants and the potential for a fall surge in infections.

"The funding was great but came up well short of the need," said Carrie Williams, spokesperson for the Texas Hospital Association. "The pandemic's impact is far from over for hospitals. We're left with staffing shortages and soaring labor and supply costs. We're vulnerable, especially if there is another surge."