During my second year at Vanderbilt Divinity School, I had the opportunity through the field education program to intern at the Tennessee Justice Center, a nonprofit law firm representing clients who navigate the complex, state run health care system called Tenncare (our version of Medicaid) and advocating for health care policy in Tennessee. Going into the internship I was most interested in how nonprofits work and engage faith communities around justice issues. I was initially anxious, recognizing I am nowhere near a health care policy expert and admittedly, even after a year with the Tennessee Justice Center, health care policy is still incredibly complex to navigate and understand.
During my time there, I interned as a faith community liaison working with the advocacy team. My task was to explore ways of connecting with community clergy. The hope was to spread more awareness of the advocacy efforts of TJC and faith leaders were to receive resources to initiate conversations in their communities around the harm being done by health care systems in our state. It was interesting work, especially as someone from rural, eastern Kentucky, a state that expanded Medicaid eligibility requirements in 2015. I was able to begin to understand the vast difference in health care accessibility for the financially vulnerable in both states.
In Tennessee in 2017/2018 there were about 280,000 people in the coverage gap. This gap is where many people fall who do not fit into the narrow requirements for Tenncare (only provided to children 19 and younger and their parents, pregnant women, women with breast or cervical cancer, and some people with severe disabilities). This leaves the small business owner just opening a new business or a young adult who just graduated college working an internship and a part time job in the “coverage gap”. Those in the gap cannot seek preventive care, regular screenings, or have lifesaving surgical procedures.
From a rural perspective, this conversation is vital. In 2014-2015, Medicaid provided health coverage for 45 percent of children and 16 percent of adults in small towns and rural areas compared to 38 percent and 15 percent, respectively, in metropolitan areas. The Affordable Care Act’s Medicaid expansion is having a disproportionately positive impact on small towns and rural areas. The rate of uninsured adults in expansion states decreased 11 percentage points in the small towns and rural areas of these states between 2008-2009 and 2014-2015, with a decrease in 3 percentage points for uninsured children.[1]
In states like Tennessee where eligibility for Medicaid is narrow for the financially vulnerable and poor, the steady stress on small rural hospitals has resulted in a range of closures. The rate of uninsured childless adults is higher, and when they visit the hospital, it often results in uncompensated care expenses. In states where Medicaid coverage is expanded to this population, we actually see that it has helped strengthen some hospitals’ financial standing. For most towns, like the one I grew up in Pike County Kentucky, the local hospital is the main (and sometimes only) source for most specialized and critical care in an entire area. If a local rural hospital shuts down, it means that patients may have to drive anywhere from two to four hours to see a specialist or receive a procedure. For those already experiencing financial difficulties and living in poverty, this simply makes health care inaccessible.
In states like Tennessee where eligibility for Medicaid is narrow for the financially vulnerable and poor, we see a continued stress on small rural hospitals that have resulted in various closures.
As someone pursuing ordination in PCUSA and specifically focusing on nonprofit and ministry in rural areas, my work at the Tennessee Justice Center led me to explore responses by churches to these health care challenges. I found that action and conversation around concrete needs are taking place and models of open dialogue about the challenges that our neighbors face in accessing health care are being constructed. A doctor in rural Kentucky voiced his plan to work with churches in order to equip church buses to be used to transport patients who can’t afford a long-distance trip to a specialist. Community clergy voiced hopes for more creative use of church space for free health screenings and clinics. As one hospital chaplain suggested to me, “Let’s bring the care to them and set up clinics in our fellowship halls.”
More conversation about possible church response to health care challenges came in response to a news article. A church in Michigan has worked with a nonprofit to pay off medical debt for over 2,000 families.[2] There was recognition that most rural churches are not equipped to undertake such a large project, but the story illustrates the potential of collaboration between churches and nonprofits.
As much as these projects and actions are all helpful and inspiring, there is more work to be done in treating the symptoms of the bigger systemic problems with health care in rural states, especially where state legislatures and governors block medicare/medicaid expansion, or underfund it. Adequate health care coverage and access to health services are integral to ensuring that people are healthy enough to find jobs, stay employed, acquire housing, pursue education, excel academically, take care of family, and flourish in everyday life. Health coverage is also integral to addressing issues in the community like addiction, mental health, and childbirth. Without adequate coverage and access, the pathways to health and wellness are essentially blocked and unobtainable to many poor Tennesseans. This results in many less-privileged Americans deciding not to go to the emergency room or rationing life-saving medication like insulin, betting that they will likely be okay until payday. Factor in that poorer Americans often work more physically demanding jobs and that the effects of poverty often cause mental health stress and inadequate diet. It becomes clear that those with the least access are in the most need of shared services.
As churches and ministers seeking to embody the healing Spirit of Christ, we have the potential to be agents of change for our communities. Concrete needs can be met but just as important is advocacy for health care policy change that considers the most vulnerable. This advocacy work can be through education, through our messages behind the pulpit, and through making connections with medical professionals and nonprofits like the Tennessee Justice Center that can speak to the needs of the area. It all starts with lifting our voices with and for the vulnerable. In light of my experience in rural Kentucky and Tennessee, the idea of a ministry that questions health care systems that commodify sick bodies and advocates for dignity in accessible health care wouldn’t be too radical – especially as we witness epidemics of opioid deaths and hospital closures.
As churches and ministers seeking to embody the healing Spirit of Christ, we have the potential to be an agent of change for our communities.
These conversations that illuminate empathy and communal response point to the fact that sickness and suffering do not discriminate. This is at once a cruel reality, and a strong argument for more solidarity from Christians and churches. Alan Storey, a South African Methodist minister, wrote a devotional responding to health care access for Sojourners that was used by the Tennessee Conference of the United Methodist Church’s “Faith that Heals” outreach. He states, “Suffering, tragedy, and illness do not discriminate. They’re not afraid to reach out and touch everyone young or old, male or female, gay or straight, black or white, rich or poor, homeless or executive, believer or other.”[3]
Storey goes on to point out that perhaps there is a strange gift in this non-discriminating nature of our finiteness. “The fact that we all suffer can sometimes help us to get over our own discriminating nature.” I want to tread lightly here at the danger of romanticizing suffering and sickness, but Storey goes further in the same devotional when he recounts his time living in South Africa under apartheid: “In the country I come from, South Africa, in the heat and heart of apartheid we had separate health facilities based on the color of our skin – probably because, maybe subconsciously, the rulers of the day thought, ‘If we let black and white people suffer together in the same wards, they may just discover the truth that they are no different from each other.’”
The indiscriminate nature of sickness, however, is counteracted when we read of Jesus’ indiscriminate healings in the New Testament. In Mark 5, the hemorrhaging woman was left in a financially vulnerable position, having spent all her money on doctors. Coming alone, she felt she had to be sneaky and hide from Jesus by crawling through a crowd and touching his robe. In Luke 5, the narrative of the paraplegic man lowered through the roof, we have the direct opposite of the hemorrhaging woman. The paralyzed man had enough community support behind him that he had multiple men carry his bed through the village and had it lowered down through a roof, forcing Jesus to confront his suffering. In John 9, the man who was born blind was perceived by the disciples to have somehow deserved his infirmity because either he or his family had sinned against God. Jesus, however, denies this notion. In all of these cases, Jesus healed them.
If there was ever an option of health care reflective of the Kingdom of God it would be not-for-profit and accessible to all regardless of class or standing. That’s not the reality we have today given our private insurance or Tenncare, where the model for medical care is big business. As the church, we know that mercy for the poorest and most vulnerable should not have to be inaccessible and this should inspire our efforts to respond to the suffering by seeking options that extends equal love and care to them. In the coming year, we will hear much more discussion of health plans, including medicare for all and a “public option” to compete with private insurance. This will provide more opportunities to begin conversations within our churches around health care justice and our response.
If there was ever an option of health care reflective of the Kingdom of God it would be not for-profit and accessible to all regardless of class or standing.
To recontextualize the question the prophet Jeremiah asks: ‘Is there no balm in Tennessee? Is there no physician there? Why then is there no healing for the wound of my people?’ When we realize the wealth of our country, we see that the healing balm is in abundance. However, it is out of reach for many of the most vulnerable in our state. How can we be mediators and exemplars of healing to those who suffer? Whether or not there is a public option, or an option for all the public, we must push for a “Jesus option” that heals the whole body of our society.
Gracious God,
May we discern your Spirit as we seek to love our neighbors and to lift our voices with those who struggle with limited resources and yet seek the health and care they deserve. We pray as the church that you empower us for this endeavor- to heed the cries of the suffering and sick and to preach and, most importantly, live out the overflowing grace of God in our communities. As a community that feels led by you to love and be a part of the healing of our neighbors, may we be attentive as we look at ways in which we can breathe new life into our mission and being. We recognize in Jesus’ healings and in our own lives that health is liberation which is being denied to the most vulnerable. May we reflect Christ as unassuming yet supportive vessels for the Spirit’s movement towards healing for all who seek your fullness of life.
God of Mercy hear our prayer,
Amen
[1] Jack Hoadley, Karina Wagnerman, Joan Alker, and Mark Holmes, “Rural Health Report: Medicaid Is a Lifeline for Small Towns and Rural Communities.” Rural Health. Washington D.C.: Georgetown University Health Policy Institute, 2017, https://ccf.georgetown.edu/wp-content/uploads/2017/06/Rural-health-final.pdf.
[2] https://abcnews.go.com/US/michigan-church-paid-off-medical-debt-2000-families/story?id=64076136
[3] Tennessee Conference of the United Methodist Church and Alan Storey, “Healing of the Nation: Bible Study.” TNUMC: Faith that Heals, 2016, https://www.tnumc.org/church-and-society/close-the-coverage-gap/healingofthenationtoolkit/.
Scot Robinson is from Pikeville, Kentucky and is a candidate for ordination in the Presbyterian Church (USA). His research interests include the intersections of health care and theology, pastoral care in rural contexts, theology based bioethics, and practical programs for health ministries that respond to poverty in areas like Appalachia. He graduated with an MDiv from Vanderbilt Divinity School in Spring of 2019.
Editorial Notes:
The Tennessee Justice Center is located in Nashville, TN. For more information about the work this organization is doing regarding rural hospital closures, click here.
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