“It’s not like there’s always a crystal-clear line between elective and emergency [procedures],” said Will Schlotter, CEO of Capitol Anesthesiology Association in Austin, Texas. “It is a complex situation.”

The $2 trillion stimulus package Congress approved this week includes $100 billion sought by hospitals to treat coronavirus patients and help the facilities recover lost revenue from canceling procedures. But hospitals have said that might not be enough to stem them over throughout the crisis.

“Let’s be clear, elective surgeries are the lifeblood of many hospitals, if not all hospitals,” said Mary Dale Peterson, president of the American Society of Anesthesiologists, who said she supports putting off elective procedures during the coronavirus crisis.

The financial implications of the decisions can be stark. One nurse at a Connecticut community hospital said the heads of surgery this week started scrutinizing each case to decide if it’s essential. Furloughs using employees' sick time are on the table if too many procedures are canceled.

One Georgia hospital this week was still performing diagnostic mammograms and X-ray procedures to assess swallowing function, according to a staffer who protested that the procedures weren’t essential. Another Texas facility was still doing joint replacement procedures earlier this week, but now says all elective procedures have been halted. POLITICO is withholding the names of facilities at the request of the health workers, who requested anonymity because they feared retribution for speaking out.

The interviews shed light on an evolving patchwork in how hospitals have responded the severest public health crisis in recent memory. And they underscore an intense level of fear these days among many health care workers just showing up for their jobs.

“We’re supposed to do no harm and be there for the patient,” said a doctor at a Texas facility. “But some surgeons — they are thinking about the bottom line and it totally ticks me off.”

Trump administration officials said factors hospitals should take into account include the urgency of the procedure, the availability of beds, and their supply of specialized gear.