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Medicaid Expansion Could Decrease State Spending

A study from the Robert Wood Johnson Foundation (RWJF) shows that Tennessee could see a decrease in state spending if Medicaid coverage is expanded.

According to the study, most non-expansion states “would increase state spending under expanding,” however this is not the case for Tennessee. 

“Tennessee’s spending will decrease slightly by 0.1 percent because the state has one of the highest parent eligibility thresholds among non-expansion states at 82 percent of FPL (federal poverty level).”

The study also estimated that more than 300,000 people would enroll in Medicaid and CHIP (Children’s Health Insurance Program) and that the expansion could lead to a decrease in the rate of uninsured people by 27 percent.

“Some would be newly eligible enrolled while others would come from the healthcare marketplace and others would transition from more expensive employer-sponsored insurance to Medicaid,” said the study.

The philanthropic health organization conducted research on the 10 states that have opted to not expand Medicaid programs. Among the 10 states are Tennessee, Mississippi, and Alabama. According to the foundation, the states have not expanded their eligibility under the Affordable Care Act.

“Under the Affordable Care Act, states have the option to expand Medicaid eligibility to non-elderly people with incomes up to 138 percent of the federal poverty level,” reads the executive summary of the study. “Governors, legislators and other stakeholders in many of the non-expansion states are actively debating Medicaid expansion.”

In 2012, the Supreme Court of the United States ruled that while Americans are required to have affordable health insurance coverage, the decision to expand coverage lies within the state. Tennessee has opted to not expand.

According to the Tennessee Justice Center, which advocates for improved health care and economic policies for families, there are “$1.4 billion of federal tax dollars per year in Washington” allocated for the state to use.

“Thanks to the American Rescue Plan’s incentive, our state could also receive an additional $900 million over two years ($1.2 million per day) over and above the cost of expanding coverage,” said the organization.

While the study does not include a state-by-state analysis, it did say that expansion would also reduce uncompensated care in Tennessee. The study cited information from the Tennessee Hospital Association saying that state hospitals “provided $1.1 billion worth of uncompensated care in 2021 for the underinsured and uninsured.”

This has also led to a number of rural hospital closures in the state.“Tennessee has experienced 16 hospital closures, with 13 of those being rural, since 2010 — the second highest rate in the United States. Of the 95 counties that make up the state, 82 percent are rural,” said the Tennessee Hospital Association.

Former Tennessee Governor Bill Haslam pushed for Medicaid expansion starting in 2013, however the state Senate blocked Haslam’s proposals. 

There are lawmakers such as Representative Caleb Hemmer (D-Nashville), who have openly advocated for Medicaid expansion. Following the release of the study, Hemmer took to his X (formerly Twitter) account to not only share highlights of the report, but to express his support of expansion.

“It’s passed (past) time we did it in Tennessee,” said Hemmer. “ A dirty little secret is Tennessee expanded Medicaid because of the COVID waivers recently and @TennCare did a great job managing the same populations that we would through traditional Medicaid Expansion. Now, the working poor who would benefit are starting to get disenrolled.”

Hemmer’s tweet references the Medicaid continuous coverage rule, which ended in March of 2023. Under this rule, states could disenroll people from Medicaid. The state had previously been prohibited from doing so due to a nationwide pause on this policy as a result of the COVID-19 pandemic.

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Cover Feature News

TN General Assembly 2020: Legislators Tackle a Multitude of Controversial Issues

The 2020 session of the Tennessee General Assembly is underway, and in many ways its tone was set even before Republican Governor Bill Lee got to deliver his annual State of the State message Monday night.

Lee, whose speech would dabble in much human rhetoric, had already expressed his compassionate side the week before when he declared forthrightly that “the United States and Tennessee have always been … a shining beacon of freedom and opportunity for the persecuted and oppressed, particularly those suffering religious persecution,” and vowed to continue offering resettlement opportunities in Tennessee to these displaced peoples. And Lee’s continued embrace of the principle of criminal justice reform was evident even before he restated it in the State of the State.

But there is another Lee, equally committed, it would seem, to a more divisive attitude toward state policy, and this Lee, too, was fully on record before he addressed the state on Monday night.

Governor Bill Lee

There is the Lee who has not only recommitted himself to the revival of last year’s moribund “fetal heartbeat” bill but has vowed to seek the kind of total ban on abortion that would set back or eliminate any sense at all of women’s reproductive freedom.

There is the Lee whose agenda, focused as it is on industrial recruitment and holding the line on taxes and spending, is content to pursue incrementalism at best in most policy spheres. “I see you,” Lee kept assuring his statewide listeners in the climax of his speech. State Senate Democratic Leader Jeff Yarbro of Nashville answered for the Democrats in his party’s official response: “The Governor may see, but it’s not clear that he understands.”

Yarbro added: “Our state is still in the basement compared to the rest of the country when it comes to public school funding, when it comes to hospital closures, drug overdose deaths, violent crime, and medical debt. We lead the nation in children losing health care, and [have] lots of counties where there are fewer businesses and fewer jobs today.”

Perhaps the most telling depiction of the gap between Lee’s vision and that of the Democratic opposition has to do with their differing price tags on educational spending. Both visions involve freeing up more money. But, after spending considerable time in the State of the State itemizing what seemed a blizzard of new initiatives, Lee proudly totaled it all up as an additional $600 million spent on education. The Democrats, in a caucus announcement two weeks ago, called for a minimum increase of $1.5 billion, more than twice as much.

But the polarities of the parties do not explain all the divisions of legislative Nashville, nor do they offer ideological guideposts to every issue. In many ways, Lee is close to the most conservative fringe of his party — not in the point-by-point way that, for example, his defeated 2018 GOP rival Diane Black, a serious right-winger, would have been, but in most of the ways already hinted at by his agenda from last year.

Jackson Baker

Lee delivers State of the State

It is no accident that a bill allowing the state to overrule local school boards on licensing charter schools and a measure funding “education savings accounts” (read “vouchers”) at the expense of Shelby and Davidson counties’ public school systems were two of his most eagerly sought goals, touted all over again in the State of the State.

His is not the right-wing populism of Trumpians or the erstwhile Tea Party; it smacks more of the paternalism of the Republican Party’s seigneurial wing, once dominant not only on the Eastern seaboard but among the country’s landed gentry and its upscale suburbs. And Lee’s conservatism on social issues attaches him to an age that is, for better or for worse, largely bygone among Gen Xers and Millennials but whose moral positions still loom large in the Tennessee hinterland.

The governor would probably accept the old George W. Bush term “compassionate conservatism” as descriptive of his views. He does not, for example, see his ideas about education as regressive. He is apparently sincere in believing that he is merely allowing state government to circumvent obsolete structures and inherited restrictions to endow  less fortunate citizens in the name of benevolence.

Although Democratic legislators from the big-city enclaves of Memphis and Nashville, both directly affected, were and remain the most conspicuous opponents of vouchers, they have by no means been alone in resisting this legalized diversion of taxpayer funding into private schools via the medium of parent applications. The voucher bill of 2019 famously passed the House of Representatives last year by a single vote, and then only after then-House Speaker Glen Casada, in determined pursuit of the governor’s agenda, suspended voting for upwards of an hour while he lobbied members of the Republican-dominated body, looking for a GOP member willing to break a tie by doing a vote change from no to aye. He finally found one in Representative Jason Zachary of Knoxville, but only after Zachary extracted a promise that the bill would not apply to his own Knox County or to anywhere else except Shelby and Davidson.

Casada was, as it turned out, much too devious for his own good in a multitude of ways and ended up the 2019 session losing a vote of confidence in his own party caucus and was deposed as speaker.

Jackson Baker

State of the State

The new speaker selected by House Republicans, Representative Cameron Sexton of Crossville, was and is a sworn foe of vouchers. One of the most intense conflicts of the current session is the disagreement between Governor Lee and Speaker Sexton over whether to expedite the voucher process, as Lee desires, or to delay it, as Sexton, and considerable numbers of both Republicans and Democrats, wants to.

As the 2020 session began, the governor found himself in conflict with virtually the entire GOP super-majority over another issue — that of refugee resettlement in Tennessee, for which, as indicated, Lee has taken a favorable stand. Sexton and 49 other Republican members of the House — including Tom Leatherwood, Kevin Vaughan, and Mark White of Shelby County — have signed on to a bill sponsored by Ron Gant of neighboring Fayette County, HB 1929, which, in the language of its caption, “prohibits the governor from making a decision or obligating the state of Tennessee in any way with regard to resettlement of refugees unless authorized by joint resolution of the general assembly.”

Donald J. Trump could not have said it any firmer. This is the same kind of prohibition which Republican state Senator Brian Kelsey of Germantown  managed to incorporate in a measure that forbade Lee’s gubernatorial predecessor, Bill Haslam, from proceeding with an acceptance on Tennessee’s behalf of the $1.5 billion reserved for the state annually under the Obama-created Affordable Care Act of 2009.

The Gant bill, and the overwhelming Republican backing of it, afforded House Democratic Leader Mike Stewart of Nashville the occasion to express both an undoubtedly sincere outrage and a priceless opportunity to probe at and widen a potential divide in GOP ranks.

Said Stewart: “There are some decisions that are better left up to the executive branch, and this is definitely one of those. The governor has made the absolute right moral decision; one that is completely his to make, based on information that he has at his disposal and without legislative second-guessing.”

From the competitive point of view, “legislative second-guessing” is the main — and perhaps the only — weapon the Assembly’s Democrats have at their disposal given the numerical disproportion they are faced with.

And, while, as indicated, Lee and the Republican super-majority are not necessarily on the same page legislatively on all issues, the members of the Democratic minority in the General Assembly have much more to second-guess about in Lee’s proposed agenda for 2020 than does the GOP majority.

Several actions taken right off the bat in the 2020 session put Lee and the Democrats at loggerheads, especially in relation to the so-called “social issues.” First and most notorious has been the governor’s announcement on January 23rd that he would support a bill that he intends to be a run-up to the aforementioned ultimate total ban on abortion.

The governor’s bill will contain a version of the “fetal heartbeat” measure that handily passed the House and nearly made it all the way through the 2019 session but was effectively halted by Senate Speaker/Lt. Governor Randy McNally on the verge of Senate passage because of doubts that it could withstand legal challenge.

Lee has indicated that his bill, which has McNally on board, will contain other “fail-safe” provisions, including bars to abortion at various points of the pregnancy calendar that have passed legal muster in prior anti-abortion measures.

Summing up the views of legislative Democrats, State Senator Katrina Robinson of Memphis — calling the Lee proposal “one of the most divisive issues brought to any state legislature” — denied the validity of the term “pro-life,” saying  that “it’s disturbing that the governor would place more effort to build a litigation strategy around abortions than he would to solve issues facing families like health care, child-care access, and funding public education.”

Similarly, though for the most part they have somewhat discreetly deferred comment to spokespersons for rights organizations, like Chris Sanders of the Tennessee Equality Project, Democrats have challenged the use by Lee and other Republicans of the nomenclature “religious freedom” to justify various legal restrictions aimed at members of the LGBTQ community.

A notorious case in point was another early-bird measure of the 2020 session, a bill passed by the state Senate and signed by Lee that allows faith-based adoption agencies to avoid penalties for declining placements for foster care or adoption on grounds of “religious or moral convictions” — in effect, to exclude LGBTQ parents from the process.

That kind of measure, like the on-again-off-again efforts in the General Assembly to bar transsexuals from gender-specific public locations (the so-called “bathroom bills,” in legislative parlance), normally engender public attention far beyond the borders of Tennessee and can arouse opposition even from Republican legislators — like state Senator Steven Dickerson of suburban Davidson County, who warned of potential backlash from business interests to the adoption bill’s passage.

This is as good a point as any to note that, despite the “us-vs.-them” struggles inherent in the two-party system, not every situation that comes up for discussion or votes in the General Assembly is of a forbiddingly binary nature. Cooperation across party lines happens all the time, as it generally has in the case of criminal justice reform, in which Republicans, expressly including Lee himself, have joined hands with Democrats in eliminating or reducing the post-release legal shackles that in times past made it difficult for ex-felons to find a place as useful, productive members of society.

One frequent participant in such joint actions is the aforementioned state Senator Kelsey, paragon of the far right and author of such partisan measures as the currently pending Senate Joint Resolution 648, which seeks to enshrine in the state constitution a right-to-work provision. The term “right-to-work” is considered a misnomer by opponents of the concept, who include virtually all trade unionists and union sympathizers. It basically allows workers to enjoy all privileges earned by unions for members of a work force without having to join or pay dues to a union, and it further protects such non-union workers from sanctions of denial of employment.

Laws establishing right-to-work have been passed before in Tennessee, and by majority-Democratic legislatures, as Kelsey shrewdly pointed out in introducing his constitutional-amendment resolution in the Senate Labor and Commerce committee last week.

Even so, Democratic state Senator Raumesh Akbari of Memphis, one of her party’s rising stars, cast the lone vote against the measure in committee, saying, “Laws like Senator Kelsey’s amendment have kept wages low and health benefits scarce for workers everywhere they’ve been enacted — including Tennessee. I believe it is wrong to use the state constitution to tie the hands of future lawmakers who may see value in the rights of workers to negotiate better pay and stronger benefits without interference from politicians.”

Still, Kelsey has in the past partnered with Democrat Lee Harris, now Shelby county mayor and then a state senator, in legislation to safeguard the Memphis aquifer from pollution and with various Democrats in criminal justice legislation. Though he probably has more detractors among Democrats at large than any other GOP legislator, he can work across the party line.

Most recently, Kelsey is a co-sponsor with state Representative Antonio Parkinson of Memphis of HB1594/SB1636, potentially path-finding legislation that “prohibits a public institution of higher education from preventing a student athlete from earning compensation as a result of the use of the student athlete’s name, image, or likeness.”

One final example of how issues, even cutting-edge ones, can defy the binary principle: A bill that made its initial appearance in 2019 was SB1429/HB1290, a measure that would modify the contractual rights of homeowners’ associations to prohibit long-term rentals. Discussion of the bill, both last year and this year, which has brought it to the brink of passage, yielded a pattern of conflicting rights and complexities within complexities, and, as of now, it needs only approval by the House Calendar and Rules Committee to get to floor votes in both chambers.

It’s a vaguely worded “caption bill” in the sense that its listed nomenclature in the legislative record is but the most general and uninformative guide to its content. It’s one of those you-had-to-be-there things, but its purport is to make it easier on absentee corporations (on “Wall Street,” as opponents of the bill put it) to convert the homes they acquire into rental properties, despite explicit prohibitions or obstacles in the protocols of homeowners’ associations.

It’s a suburban issue, a complex one in which each contingent claims to have justice on its side and each side accuses the other of violating property rights. Win or lose, in the long run it will invite litigation. In the meanwhile, it is one more reminder that there isn’t necessarily a Democratic or a Republican way to do the public’s business. Sometimes not even a right or a wrong way.

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Editorial Opinion

Arithmetic Don’t Lie

Former President Bill Clinton is considered to have given former President Barack Obama a serious boost toward re-election at the Democratic National Convention of 2012. That was by means of an elongated  address, both eloquent and something of a vamp, in which Clinton, among other things, credited his fellow Democrat with possessing a sagacity, one lacked by the competing Republicans, in dealing with the ravages of the then-recent economic crash.

Clinton said he could sum up the difference in one word: “Arithmetic!” The line brought down the house, but it was more than good theater. There was a sense in that statement that made it more than a punchline, that in fact summed up one of the fundamental differences between the two major parties in their recurrent debates over fiscal policy, wherein the Republicans talk (but don’t necessarily practice) solvency, while the Democrats prefer to emphasize (not always wisely) financial remedy.  

There came a similar point of epiphany Monday night in the official Democratic response to Republican Governor Bill Lee’s 2020 State of the State address, delivered by state Senate minority leader Jeff Yarbro of Nashville. It is worth quoting at length. In one of his several concessions to the principle of governmental activism, Lee boasted about the $117 million he proposed adding to the salaries of the state’s teachers. “$117 million,” Yarbro mused. “That’s just a little bit more than the $110 million that vouchers are supposed to cost the state once they’re fully implemented. So in a lot of ways, we’re not even sure if we caught up with last year’s losses before we we start filling in the holes.

“So it’s good news. But it’s not clear that we’ve really made the steps that we need to. Tennesseans don’t expect their state government to spend foolishly; they expect us to live within our means. But just imagine how much more we could afford if we weren’t wasting money on private school vouchers. If we weren’t sending almost $1 billion of childcare TANF [Temporary Assistance for Needy Families] funds back to the federal government, if we weren’t sending $1 billion a year worth of Medicaid funding  back to the federal government.

“And this is a big deal. The governor announced a lot of initiatives tonight focused on mental health care and substance abuse, and make no mistake about it, some of those ideas are great, ideas that we all support. But here’s the reality: Tennessee  could spend less money to reach more communities and help more people if we just simply join the other 36 states that have expanded Medicaid. That $300 million in initiative could go toward shoring up TennCare, providing new access and safety nets and pilot projects. That’s $300 million that could have gone straight into public education, if we had just expanded.”

Back in 2012, we found Clinton’s point to make good sense, and we find what Yarbro had to say on Monday night just as agreeable. In the jam-packed week of public events we’ve just gone through, we were mightily impressed by Shakira’s rendition of “Hips Don’t Lie” at halftime of the Super Bowl. And Yarbro’s numbers: They don’t lie either. Less sexy, maybe, but profoundly more serious.

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Politics Politics Beat Blog

Block Grants Bill Advances Despite Memphians’ Protest

JB

Dwayne Thompson musing during block grant hearing

NASHVILLE — Two Memphis Democrats, state Reps. Dwayne Thompson and Larry Miller, did their best on Wednesday to put the brakes on a proposal, emanating from the Republican leadership of the General Assembly, insisting that federal Medicaid funding to Tennessee be in the form of block grants.

But, like it or not, and there is no indication that Gov. Bill Lee is opposed to the concept, HB1280, which requires that the governor request the state’s Medicaid funding via block grants, advanced a step closer to him on Wednesday in newly strengthened form.

The bill was amended in the TennCare Subcommittee on Wednesday by voice vote and is on its way to the full House Insurance Committee with an amendment from the bill’s sponsor, Rep. Timothy Hill ( R-Blountville), requiring legislative approval of any block-grant arrangement reached with the federal government. Meanwhile, SB1428, the Senate version sponsored by Senator Paul Bailey (R-Sparta), is pending before the Senate Commerce and Labor Committee.

In the TennCare Subcommittee, Reps. Thompson and Miller objected to the amendment and then to the bill as amended. Thompson had asked sponsor Hill how many other states received their Medicaid funding via block grants and when Hill professed not to know, Thompson supplied the answer: “I understand that it’s zero.” He then asked why Hill was proposing that the state pursue the “experiment” of block grants.

Hill alluded to the state’s volunteer tradition. “It’s the Tennessee way,” he answered. “Why not?”

Rep. Jason Zachary (R-Knoxville) responded similarly. “Let’s be the first. Let’s be the precedent,” he said.

Subcommittee Chairman Rep. Matthew Hill (R-Jonesborough) then indulged himself in what he himself branded as a “joke” by saying, “Chairman Hill, this is a great bill!” He went on to express enthusiasm that Tennessee, “known for innovation,” could by passing the bill, escape the “fetters of federal intervention” and maintain control of Medicaid spending at the state level.

In a brief question-and-answer session with reporters afterward, Hill exulted that his measure had passed its “first hurdle” and was presumably on its way to full passage. He acknowledged that there was some opposition to the bill, to be expected “whenever you’re proposing something that’s cutting edge.”

Asked whether there was polling to suggest popular support for his bill, Hill said he hadn’t conducted any. But he expressed confidence that the bill has “broad support…certainly with this supermajority” and would pick up more support “as we go along.”

He said he had “sat down” with TennCare officials but could not say what their opinion on the measure was. He acknowledged that the terms of the bill could alter the way TennCare operates but did not elaborate.

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News The Fly-By

University of Memphis Grad Assistants Demand Health Coverage

When Le’Trice Donaldson was a graduate assistant (GA) at the University of Memphis, she was diagnosed with breast cancer. But because the university doesn’t offer health coverage to GAs, and her income from the university was only $900 a month, Donaldson wasn’t sure how she would afford medical care.

“The first thing that came to my mind after my diagnosis was, ‘How am I going to pay for this?'” Donaldson said.

Luckily, Donaldson qualified for a TennCare loophole that only applies to breast cancer patients. But not every GA is so fortunate when he or she gets sick. Around 25 percent of

Bianca Phillips

United Campus Workers demand Medicaid expansion during Bill Haslam’s recent visit to Memphis.

U of M GAs have no health insurance.

Additionally, those whose stipends fall below $11,490 per year don’t qualify for Medicaid or for subsidies through the Affordable Care Act (ACA). Had Governor Bill Haslam chosen to expand Medicaid after the ACA was passed, those GAs would have access to health coverage subsidies through the ACA Marketplace.

Now, United Campus Workers has begun putting pressure on the university to provide health insurance to GAs and the state to expand Medicaid.

GAs are employees of the university. While they attend classes toward their own graduate degree, they’re also teaching classes for undergrads or working in research labs.

Since they’re working at the university, their tuition is waived, and they receive a stipend, but the amount of that stipend differs by department. Some make less than $11,000 a year and others top out at $18,000.

They’re not allowed to hold additional outside jobs because, according to Interim Dean of the U of M Graduate School Jasbir Dhaliwal, “they are full-time students, and we want them to focus on their studies.”

Josh Dohmen, a GA in the philosophy department, helped compile a report on how other schools handle insurance for GAs. Of the U of M’s academic peers (schools that are comparable to the U of M based on academic accomplishment), 75 percent offer full health coverage to GAs. Of the U of M’s funding peers (schools with similar financial resources), 50 percent provide full coverage. The University of Tennessee system provides health coverage as part of their GAs’ stipends.

Dohmen’s report, which was compiled last academic year, also surveyed U of M students about their personal health insurance situations — 25.1 percent of the

U of M’s GAs were uninsured; 37.2 percent were on a parent or spouse’s plan; 22.1 percent were on a U of M student plan (but as of this academic year, that student plan no longer exists); and 15.6 percent had coverage under the ACA.

“We brought that report in to the administration of the Graduate School, and we were told that we shouldn’t be asking the university for funding, but that we should be putting pressure on the state to fund the university better,” Dohmen said. “I think it’s the case, if they wanted to, they could give health insurance to their GAs. But if that is legitimately not the case and I’m wrong, they need to be the ones putting pressure on the state. They have lobbyists in Nashville.”

Dhaliwal said, “In a perfect world, we certainly would like to provide health insurance.” But he said funding for GAs is limited.

“If we were to start offering health insurance, the number of GAs we could have would be less,” Dhaliwal said. “We feel there’s a shortage in the community for advanced degrees, and we’re trying to provide as much education as possible to as many people as possible.”

Dohmen said United Campus Workers will continue to pressure the university and the state. Just last week, outside the Shelby County Health Department while Haslam was in Memphis getting a flu shot, they held a protest to demand the state expand Medicaid.

“I plan to take my report [on how other schools handle health coverage] to the administration of the University of Memphis,” Dohmen said. “And I am in talks with University of Tennessee-Knoxville to draft a statewide letter saying [health coverage] is what we need. We need to raise awareness to folks making financial decisions for the state.”

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Editorial Opinion

Keeping Hospitals Alive

The pending shut-down of Crittenden Regional Hospital in West Memphis, which followed several months of highly publicized financial crisis, should sound the alert for medical authorities in Memphis — especially at Regional One Health (formerly known as The Med), which will inherit much of the now stranded patient load at the expired hospital.

The loss of Crittenden Regional and the resultant further shift of the medical burden to Regional One highlights once again still unresolved questions of the degree to which both Arkansas and Mississippi should compensate the Memphis facility for taking care of underprivileged patients from those states who seek medical assistance on our side of the state line.

And the closing of the facility in Tennesssee’s neighboring state should stand as both a warning and a reproach to Governor Bill Haslam and the Tennessee General Assembly — the latter for its callous indifference to the needs of our state’s stressed and financially challenged hospitals, as evidenced in the Republican-dominated legislature’s persistent refusal to consider Medicaid expansion funds available through the Affordable Care Act (Obamacare), and the former for letting himself be cowed into acquiescing in that refusal.

As Tennessee law now stands, the General Assembly having passed legislation in last year’s session giving itself de facto veto power over any future decisions Haslam might make on the issue, the governor’s hands are more or less tied. But he had ample opportunity before that point, when hospital administrators all over the state were begging him for financial relief, to avail himself of Medicaid expansion funds. He should have accepted the funds, even at the potential cost of inviting threats to his reelection. No profile in courage there, Gov.

It is true, of course, that Crittenden, like other public hospitals in Arkansas, had the benefit of Medicaid expansion funds, thanks to the fact that the state’s governor, Mike Beebe, is a Democrat, like the president, and therefore is not bound to an ideology of refusal that too many Republicans, for purely political reasons, are bound to. That fact alone kept the hospital alive for a season or two. But a pair of serious fires at the facility, one as recently as this year, pushed the hospital over the fiscal cliff.

There are numerous hospitals in Tennessee that are teetering on the edge of bankruptcy, and, failing the kind of unforeseen accident that happened in Crittenden, could easily survive with a fair share of the $2 billion that our state officials have opted to deny them.

Back to Arkansas: Another Democrat, U.S. Senator Mark Pryor, is running for reelection with a campaign that features public speeches on behalf of Obamacare/Medicaid expansion (both of which, however, he, rather too cautiously, calls by euphemistic names), pointing out that he himself was able to survive a bout with cancer in the 1990s, despite the fact that his insurance company back then declined to pay for the expensive treatment he required, which he then had to pay for out of pocket.

Obamacare, Pryor notes, prevents insurors from doing that to others. It can help keep hospitals alive, too.