Kamala Harris plans to expand access to healthcare. (Photo: Hush Naidoo Jade Photography | Unsplash)
As the November election approaches, the nation again nears a crossroads on healthcare, with candidates diverging on a basic question of equity: Who is to bear the risks and costs of care? For Donald Trump, his congressional allies, and conservative policy analysts, the answer is clear: cut government spending and shift the risks and costs back onto individuals, employers, and states. For Kamala Harris, the priorities move in a strikingly different direction: expand access to healthcare, strengthening the federal government’s role in guaranteeing healthcare for all Americans, no matter what their socioeconomic status may be.
The differences show up most pointedly in the candidates’ positions on the Affordable Care Act (ACA) and Medicaid. Fourteen years after Congress passed the ACA, providing subsidies that enabled millions of Americans to obtain health insurance, the percentage of uninsured Americans has declined to a historic low of less than eight percent. Vice President Harris has advocated for, and defended, the ACA, and is expected to support the extension of enhanced subsidies, introduced during the pandemic, beyond their expiration date of 2025. These subsidies have made it possible for many people to obtain marketplace coverage.
Donald Trump tried and failed to repeal the ACA in 2017, and since then he has vowed he “would make it much better than it is right now,” though without providing specifics. One likely course of action, however, would be to target the ACA’s protection of individuals against insurance denial because of preexisting health conditions. As president, Trump authorized the expansion of short-term insurance plans as an alternative to the more comprehensive ACA marketplace plans. These short-term plans allowed insurers to bar people from coverage because of preexisting conditions, and to set rates based on their medical histories.
More recently, the Republican Study Committee, a group comprising four-fifths of Republican congressional members and their leadership, released a budget proposal calling — among many other things — for an end to the federal government’s regulation regarding preexisting conditions, and allowing states to decide whether or not to keep the rule.
Medicaid also represents a major difference between the candidates. A joint federal-state program established in 1965 along with Medicare, Medicaid now provides health insurance for almost 75 million low-income Americans. When Congress passed the Affordable Care Act in 2014, it included a provision to expand Medicaid coverage to all Americans earning up to 138 percent of the Federal Poverty Level. Forty-one states, including the District of Columbia, adopted the expanded coverage, along with federal matching grants to go with it, and 10 states (primarily Republican-controlled states) rejected it, keeping insurance out of reach for many low-income residents.
As president, Donald Trump approved waivers allowing states to set work requirements in order for people to receive Medicaid, and waiver programs have proved costly and ineffective. The Biden-Harris administration withdrew those waivers, claiming that work requirements do nothing to advance the purpose of Medicaid, which has been to expand access to healthcare.
What should voters make of these differences? One way to begin answering the question is to listen to people closest to the issues. An internist working at a San Francisco public hospital writes of treating an indigent man who requested hospice care rather than undergoing an amputation for a bone infection in his arm, an infection that didn’t respond to antibiotics. The man explained that with an amputated arm, he’d be much more vulnerable to assault on the streets, and thus he opted for hospice — unless he was able to get housing — a goal far out of reach in a city with a critical shortage of available housing.
The man eventually died of sepsis (the physician refers to the cause as “end-stage poverty”), and the internist explains, “ … that illness in our patients isn’t just a biological phenomenon. It’s the manifestation of social inequality in people’s bodies.”
The U.S. spends more money per capita on healthcare than any comparable nation in wealth and size, and yet life expectancy in the nation is lower than that of any peer nation. There are many reasons for this, one certainly having to do with the U.S. being the only advanced nation without universal healthcare for its citizens. Poverty and racism factor significantly as well, with persistent indicators like major racial gaps in maternal and infant mortality. A recent California study found that babies born to the poorest Black mothers have almost twice the mortality rate of the poorest white mothers, and even babies born to the wealthiest Black mothers have a higher mortality rate than the poorest white mothers.
The U.S. has been slowly moving in the direction of other advanced nations, gradually increasing the federal role in guaranteeing healthcare for all. This November’s election will be a referendum of sorts, indicating a continuation of the present direction or a significant reversal of policy. At stake is a choice between leaving individuals more or less to their own devices in a highly unequal society, or recognizing that healthcare — and the eradication of inequity — is a collective responsibility.
Andrew Moss, syndicated by PeaceVoice, writes on labor, nonviolence, and culture from Los Angeles. He is an emeritus professor (nonviolence studies, English) from the California State University.
State Capitol (Credit: Tennessee State Government)
Outgoing Republican Representative Sam Whitson is mulling a reversal of state law requiring the governor to gain approval from the legislature before expanding Medicaid.
Whitson, a Franklin lawmaker who recently announced he will not seek re-election in 2024, said Tuesday he’s been considering such a measure for two years with Tennessee forgoing billions in federal funding that could enable the working poor to obtain insurance coverage. He has not filed a bill yet.
The amount Tennessee is losing ballooned from about $1 billion in 2014 to $2.1 billion this year, according to healthinsurance.org.
“We should give the governor the opportunity to explore options,” Whitson told the Tennessee Lookout. “I’m not saying we need to do Medicaid expansion. I just think that was a restrictive bill done for purely political reasons to enhance Kelsey’s and Durham’s political future.”
Former Sen. Brian Kelsey, who pleaded guilty to federal campaign finance fraud but is fighting to reverse the plea, and former Rep. Jeremy Durham, who was expelled from the House in 2016 for 22 cases of sexual misconduct, passed the resolution in 2014 requiring legislative approval of a plan that former Gov. Bill Haslam was negotiating with the federal government.
Haslam’s Insure Tennessee proposal would have expanded TennCare coverage to some 250,000 uninsured and underinsured Tennesseans, giving them the opportunity to obtain health insurance through private providers, in some cases through a small premium.
Even though the legislature directed Haslam to come up with a plan, a Senate health committee rejected it on a 7-4 vote, stopping it from reaching the House or Senate floor.
Whitson, a member of the House Health Committee, said he is talking to colleagues to see if changing the state law has “traction.”
“We leave a lot of money on the table with that. I’m a big supporter of helping the working poor, people who work and try to make a living and are caught in that gap,” Whitson said.
Tennessee is believed to have more than 300,000 uninsured and underinsured people in a gap between TennCare and Affordable Care Act coverage.
Gov. Bill Lee has refused to take up the matter, consistently saying since his first election five years ago he believes the Affordable Care Act, through which 40 states expanded Medicaid, is “fundamentally flawed.” Since then, Tennessee has lost billions annually to other states.
Democratic Rep. Caleb Hemmer of Nashville, a House Health Committee member who penned an op-ed on the matter, pointed out 70 percent of Tennesseans said in a recent Vanderbilt poll they back Medicaid expansion. He favors a change in the law that restricts the governor’s ability to negotiate with the feds and set policy for Medicaid expansion.
“It’s a pathway,” Hemmer said of Whitson’s idea. “I’m a little concerned our governor wouldn’t do it even if we did pass the law, based on his prior comments.”
Studies show the state could widen coverage to 150,000 to 300,000 and save money, in addition to reducing medical bankruptcies, expanding mental health resources and preventing rural hospital closings, according to Hemmer.
We leave a lot of money on the table with that. I’m a big supporter of helping the working poor, people who work and try to make a living and are caught in that gap.
– Rep. Sam Whitson, R-Franklin
He pointed out the Affordable Care Act passed “a generation ago” and “the world has moved on” to other topics. In addition, Tennessee has a federal Medicaid waiver that gives the state flexibility to use TennCare savings to provide more services.
Lawmakers such as Republican Rep. Kelly Keisling of Byrdstown, who represents one of the state’s most rural districts, back Medicaid expansion but can’t find enough support within the Republican Caucus to push it to passage.
Gaining enough votes would be difficult, mainly because Obamacare and the resulting Medicaid expansion became a national political hotpoint a decade ago. Rejection of Haslam’s plan led to yearly protests at the Capitol, but Republican lawmakers haven’t budged since then.
House Health Committee Chairman Bryan Terry said in a short statement Tuesday “any Medicaid changes will have an impact on our budget; thus, should go through the legislative process.”
Haslam’s proposal was expected to cost the state $200 million, about 10 percent of the overall expense, which was to be paid by the Tennessee Hospital Association.
Democratic Sen. Jeff Yarbro of Nashville and Democratic Rep. Larry Miller of Memphis sponsored a bill during the 2023 session removing the requirement for the legislature to approve a governor’s decision on Medicaid expansion. It didn’t move through the House or Senate committee systems.
Tennessee Lookout is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Tennessee Lookout maintains editorial independence. Contact Editor Holly McCall for questions: info@tennesseelookout.com. Follow Tennessee Lookout on Facebook and Twitter.
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.
Craig Fitzhugh, who these days serves as mayor of nearby Ripley, Tennessee, is better known for his many years of service in the General Assembly, where he was leader of the House Democratic caucus before retiring from the legislature in 2018 to make a run for Governor.
One of Fitzhugh’s big issues in those years was medical care, and it remains a major concern now, something he made clear in addressing members of the Rotary Club of Memphis via ZOOM on Tuesday.
The state does offer TennCare for its disabled and indigent citizens, but the scope of that program’s coverage is limited to something like a million people, he said. “And once you have any income at all, you’re not really eligible for Tenncare.”
Tennessee, he pointed out, is one of only 13 states that, at this point, have not accepted the federal government’s offer to expand Medicaid funding, to the tune of something like a billion dollars a year under the Affordable Care Act, which began under the Obama administration. And, said Fitzhugh, President Biden has “sweetened the pot” by offering Tennessee another $1 billion as a bonus for accepting Medicaid expansion now. Acceptance is entirely dependent on a state’s decision, as a result of a U.S. Supreme Court decision in 2012, and Fitzhugh called Tennessee’s continuing failure to do so “probably the worst mistake” in the state’s history.
“The truth of the matter is, there is no real reason why Tennessee has not expanded Medicaid. no real reason,” Fitzhugh said, the reasons being, as he explained, matters of politics and ideology, with the popular name for the program, “Obamacare,” probably looming larger than any other factor to the Republicans in control of state government. “And the only reason left, if there is one, is people calling it ‘Obamacare.’ ”
The program, as Fitzhugh noted, would provide significant medical services for all Tennesseeans whose income amounts to 138 percent of the official poverty line. “These are working people that either can’t afford medical insurance or their employer can’t afford it for them. So the thing that people didn’t realize about Medicaid expansion is, it helps working folks. And if you put that hat on, then you will know what kind of growth it would give, not just from a fundamental standpoint, but from an economic standpoint.”
Former Governor Bill Haslam devised a state program in 2013 that he called “Insure Tennessee” that was designed to work with the Affordable Care Act, but state Senator Brian Kelsey (R-Germantown) had meanwhile contrived to pass legislation making acceptance of Medicaid expansion contingent upon joint legislative approval. And, said Firzhugh, there seemed to be “some informal agreement as to who would come first, between the House and the Senate,” both Republican-dominated, and neither would take the first step.
Democrats were too much of a minority to move things all by themselves, “though we did our best,” said Fitzhugh.
In the beginnings of the Affordable Care Act, the federal government footed 100 percent of the costs of an accepting state’s expansion. It now pays for 90 percent of it, as envisioned in the plan’s original timetable. As Firzhugh pointed out, the state Hospital Association stood ready to guarantee the odd 10 percent back then, and he foresaw little difficulty in arranging a coalition to defray those costs now.
“And as I said earlier, this expansion is not just for the disabled or unemployed persons. It is for those people who just cannot afford it. And think of the difference that it would make if somebody could have regular medical checkups, find problems early, especially chronic situations, like heart disease, diabetes, and all that.” Even COVID, he added.
“And I still say if that thing got to the floor, then public opinion would come about, the stations would come about, the hospitals would come about,” and Tennessee could yet enjoy the medical and economic benefits it has been forfeiting, Fitzhugh said. And he expressed hope that his friend Randy McNally, the current lieutenant governor of Tennessee, was moving in that direction.
“There is no moral, medical, or monetary reason why Tennessee should not expand Medicare,” Fitzhugh said, and the failure so far to do so remains the state’s greatest mistake.
And then Jesus drug tested everyone using taxpayer money before deciding if the lazy, freeloading masses were worthy enough to receive fish and bread.
“I can’t feed these people,” said GOP Jesus, an internet meme. “It will destroy their incentive to better themselves.”
Once their urine tested clean, Jesus reminded them that this was temporary assistance and warned against becoming dependent on his handouts. He went on to explain that tax revenues were actually for corporate subsidies and funding war. — Reddit meme, 2021
Tennessee Capitol Building as viewed from Bicentennial Capitol Mall State Park in Downtown Nashville (Photo: Brandon Hooper)
Tennessee Republicans believe that “giveaway money” (more commonly called unemployment benefits) is funding a “lifestyle alternative,” keeping many “from pulling up their bootstraps and achieving the American dream,” and that 300,000 Tennesseans should not have healthcare.
This year, GOP lawmakers cut the time for state unemployment benefits in half. They cut the time Tennesseans could get unemployment benefits from the federal government by two months. They also said no (again) to $1.4 billion that would have expanded TennCare, Tennessee’s Medicaid program.
As for the free money from the federal government, Elena Delavega, the poverty expert from the University of Memphis, said she’s wondered why lawmakers would not take it, and she then came to a disturbing conclusion.
“Sometimes — and I don’t want to think so — it seems like the purpose is to, in fact, hurt people,” said Delavega.
Cutting unemployment benefits and failing again to expand TennCare were two major moves that affected poor people across Tennessee, one of the 10 poorest states in the country. Insiders would add to that list other moves affecting mass incarceration, hikes on loan fees, education spending, “right to work” labor status, PAC donation limits, and more.
To outsiders, it may seem like the GOP supermajority that has run Nashville for the last 10 years has professionally crafted an anti-poor, pro-business playbook, locked arms, and expertly executed dozens of moves to lock the state deeply in conservative economic theory.
But it looks more coordinated than it is, according to one insider who said Republicans in the Capitol were just not that put together. The source organized the state GOP in three groups: a majority who treat the job like a “social hour or retirement home” and go along with whatever their majority leaders command, another group comprised of “true believers” — some of whom believe their “own bullshit,” and a final group that carries out the bidding of corporate special interests, chambers of commerce, and the institutional donor class.
“Business essentially runs the Capitol up here with the exception of the crazies in the gun lobby and the anti-LGBTQ community,” the source said.
It’s no secret that Republicans hate government handouts. Remember Ronald Reagan’s “welfare queens”? Well, maybe they just hate some handouts, it seems. They crow about taking $1 billion in CARES Act funding to shield business owners from unemployment insurance hikes, and they use millions of dollars in federal handouts for an ongoing series of multi-million-dollar, no-bid contracts related to COVID-19. Tennessee Lookout editor Holly McCall found that more than a dozen Tennessee GOP lawmakers took federal handouts to bail out their businesses during the pandemic.
Still, government handouts are bad for poor people and the working class, they seem to say. On May 12th, for example, Tennessee Governor Bill Lee tweeted, “Work is good for the soul, good for families, and good for Tennessee. We shouldn’t be incentivizing people not to do it.”
When asked why it seemed GOP lawmakers targeted poor people, Eric Atkins with the Tennessee Poor People’s Campaign responded with a question of his own.
“Well, how many lawmakers in Nashville do you think we can classify as poor?” Atkins asked.
Governor Bill Lee (Photo: tn.gov)
Kicking the TennCare Can
If he wanted to, Governor Lee could Thanos-snap his fingers and expand TennCare, flowing $1.4 billion into the state. Lawmakers here have possessed the tools to do this since 2014, even during the tenure of the Trump adminstration. They have not.
Then-Governor Bill Haslam said no to even the thought of it in 2013. Back then, he was arguing with federal officials for his “Tennessee Plan,” a nontraditional, private schema for broader healthcare access. For weeks, Haslam had been dogged with questions on whether he would take the promised $1 billion (at the time) available under the Affordable Care Act to expand TennCare rolls. “Governor Bill Haslam finally had something to say on the issue Wednesday, and it was a very hedged no,” the Memphis Flyer’s politics editor Jackson Baker wrote at the time.
There was a problem with the money then, and it still exists today: the word “Obama.”
“What the governor would like to do, to appease his base, is have access to the Obamacare dollars without subscribing to the Obamacare plan,” state Representative G. A. Hardaway (D-Memphis) told Baker in 2013.
Republicans at the time said the Affordable Care Act was shoved down their throats by a Democratic majority, led by then-President Barack Obama. Right-wing talk show hosts and keyboard warriors vilified Obama, called his healthcare solution “socialist,” and dubbed it “Obamacare.” It’s been a lightning rod Tennessee GOP members still won’t touch.
When asked about years of failure to expand Medicaid here, state Senator Raumesh Akbari (D-Memphis) signaled exasperation and irritation with a “wooooooooo” that indicated the subject was still a hot button. She remembered her days in the House, hearing each day of how much money Tennessee was giving to other states by not expanding Medicaid, but other members at the time said, “We don’t want to be tied to Obama. This is Obamacare.”
She describes the ongoing unwillingness to expand it as a “politics-over-policy situation.” For it, 964 Tennesseans died from 2014 to 2017, according to the latest data from the Center on Budget and Policy Priorities (CBPP), a left-leaning Washington think tank. Many say the decision has also expedited the closure of 13 rural hospitals, the second-most closures in the country behind Texas, according to Becker’s Hospital Review.
“We just went through the worst health crisis in 100 years, and you had people in rural communities who had to be airlifted to Vanderbilt and to parts of Memphis just so they could seek care,” Akbari said. “A lot of our complications from COVID come from chronic diseases that certainly could have been managed better through actual, preventative healthcare.
“And the fact that the federal government is giving us an added financial incentive to expand Medicaid and we don’t, to me, it’s criminal.”
Expanding Medicaid would have a bigger economic hit than Amazon moving to Tennessee, said Michele Johnson, executive director of the Tennessee Justice Center. Pushing $1.4 billion into the state’s economy that would ripple out to businesses and people across the state. It would also save Tennessee taxpayers $900 million over two years. But those facts pale to another.
“We know that people are living shorter lives,” Johnson said. “They’re dying of preventable causes, and they’re suffering in ways that they would not be suffering if they were in most any other state in the nation.”
Lt. Governor Randy McNally (Photo: Wikimedia Commons)
The door cracked on TennCare expansion earlier this year, but just a tad before it was slammed shut again. High-ranking Republicans, including Lieutenant Governor Randy McNally, said they just wanted to peek at the sweetened pot for Medicaid expansion left by President Joe Biden. It didn’t happen here. Nor did it happen in Alabama or Wyoming, where conservative lawmakers reviewed similar deals for expansion.
Conservatives across the country are softening on expansion, according to a story by The Pew Charitable Trusts. The story said it wasn’t quite a “conservative bandwagon but momentum is certainly moving one direction.” Many states — including red states — are watching the benefits seen with expansion in other states.
Jesse Cross-Call, a senior health policy analyst with the Center on Budget and Policy Priorities, told Pew that “there’s been a ton of evidence showing large gains in healthcare coverage, while helping states economically and keeping rural hospitals open. And it hasn’t hurt state budgets. It remains a really good deal for states to cover hundreds of thousands of people.”
While the door shut on traditional Medicaid expansion, Republicans were catcalling a new, experimental healthcare plan from Governor Lee, approved in the waning days of the Trump administration. That plan, Lee says, would give Tennessee more control of healthcare spending, save $1 billion annually, and, somehow, not change eligibility, meaning the folks who can get TennCare today could get it under his new plan.
In a January tweet, Lee said Tennessee will “lead the nation with our innovative solution to Medicaid,” and “this new flexibility under the block grant model allows us to improve the health of Tennesseans and our communities.” The first reply to his tweet was from @NashvilleChick who wrote, “murderer.”
“Real Ebenezer Scrooge Stuff”
Republicans here never out and out called anyone “lazy.” But though they never used the “l” word in committee meetings or on the floors of their respective houses, they came close, and it was plain they thought it.
In numerous anecdotes, they’d get heated — angry — as they recounted stories of their business buddies who just could not find anyone to hire for their restaurants. One Knoxville House member got so hot, he said he wished Amazon wouldn’t bring any more jobs there; there was no one to work, he huffed into the microphone. The GOP members’ reason, according to their gut and not one single piece of data, was that people were getting government checks and staying on the couch.
State Representative Kevin Vaughan (R-Collierville), sponsor of legislation cutting state benefits, said when people “on the interweb” and “on the Twitter” talk about this issue, “they get pretty passionate.”
“The origins of this bill is financial mathematics on how to make sure that a trust fund is available to the citizens of Tennessee when they need it,” Vaughan began, giving the mechanical, high-minded explanation of the bill that had become his standard rhetoric as he shepherded it through the committee system. But on the House floor for the final vote that day, he didn’t stop himself there. “But we have seen our country in the last six months devolve into a situation where people are counting on and relying on the checks from the government, instead of pulling themselves up by their bootstraps and achieving the American dream.”
Vaughan’s bill, co-sponsored by state Senator Jon Lundberg (R-Bristol), cut the amount of time Tennesseans could get state unemployment from 26 weeks (just over six months) to as low as 12 weeks, the lowest in the country. In his nasally Michigander drawl, Lundberg repeated time and again that “the 10-state average of [unemployment benefits in] Southern states is 11.5 weeks. Tennessee is the highest of those states.”
The Republican supermajority, it seemed, wanted to line up at the bottom when it came to how much help they gave to citizens in need. Lundberg’s only regret, he said, was that the new structure could not go into effect any faster than in 2023.
“This is some real Ebenezer Scrooge stuff,” argued state Senator Jeff Yarbro (D-Nashville) from the Senate floor last month. “There is no economic theory that suggests that cutting off benefits actually pushes people to work. Actually, I would say the last 12 months disproves that. You haven’t had a lot of Tennesseeans who’ve just stayed at home over the last 12 months; they’ve gone back and gotten jobs.”
Federal Reserve chair Jerome Powell said last month the bottlenecks in the labor markets could be because of lingering COVID concerns, the inability to find childcare, and more. But he said it “was not clear” that they were caused directly by unemployment checks. But that word from the Fed chair didn’t stop Tennessee Republicans from laying the blame right at the feet of the unemployed.
“To tell you the truth, I’m not sure what world my colleagues from the other caucus are living in,” said state Senator Mike Bell (R-Riceville) on Democrats’ arguments against the cuts. “You go around any county in this state right now, and you see ‘Help Wanted’ signs everywhere. … The jobs are out there, and it’s time we quit incentivizing people staying home.”
A Capitol insider said the benefits cuts were sold by Republicans through anecdotes, not data, and all of them saying one thing: Democrat checks are making folks not want to work anymore.
For instance, Bell pointed to the “guy who is building my cabinets right now,” who is now having to build his own cabinets “because he can’t find anybody to show up for work.” State Representative Eddie Mannis (R-Knoxville) said the workforce in Knoxville was so sorry he complained of 750 new Amazon jobs there, saying, “I’m, like, don’t bring any more jobs or companies here. We don’t have the workforce to fill the jobs we have.” State Representative Pat Marsh (R-Shelbyville) complained he had 100 idle trucks with no one to drive them.
“When you get a mailbox check every week, human nature is you’re sitting at home, and some of those people need to go back to work,” Marsh said. “We have to cut out this giveaway money and get our people back to work.”
State Representative John Ray Clemmons (D-Nashville) attempted to dispel some of what he called this “false narrative” with facts. The max state payout is $275 per week, he explained, or $6.88 per hour, or $1,100 per month, or $13,200 per year. Add $300 in the current federal unemployment benefit, and the number rises to $27,600, just slightly above the federal poverty limit for a family of four, he said.
“The unemployment system is in place for a reason,” Clemmons said, “so don’t use the false narrative that people want to make less than the minimum wage as an excuse for them not filling jobs. Workforce issues in this state have been an ongoing problem.”
It’s clear Governor Lee believes the narrative, though. In an executive action last month, he opted Tennesseans out of the $300 in additional federal unemployment benefits. The day after, he hit send on that tweet about how “work is good for the soul, good for families, and good for Tennessee. We shouldn’t be incentivizing people not to do it.”
“Luxury of Ideology”
The debate on Medicaid expansion is ongoing in 12 states. The debate on unemployment checks and workforce shortages is national as evidenced by the talking-heads’ rhetoric last week following the slightly disappointing May jobs report.
But people here need help now, said Johnson from the Tennessee Justice Center, and they don’t have the luxury of ideology. When asked if it seemed Republicans here actively schemed against poor people, she said it was more a “failure to understand regular Tennesseans.”
“Are our elected officials sitting around trying to figure out how to torture poor people? I don’t think so,” Johnson said. “But I think it’s a lack of accountability and curiosity [of everyday citizens] that is, frankly, very deadly for the people of the state. And I think we’ll be paying for it for generations.”
Two Medicaid expansion bills were sent back to the waiting room of the state legislature Wednesday during a time when Tennessee hospitals are hurting and uninsured rates soar.
Before the Tennessee General Assembly broke early this session, Rep. Ron Travis (R-Dayton) brought the idea of Medicaid expansion back to the legislature with a package that closely resembled former Governor Bill Haslam’s Insure Tennessee proposal.
The legislature is back in session but only to vote on bills related to the state budget, COVID-19, and other items deemed time sensitive.
Senator Jeff Yarbro (D-Nashville) brought two, simple bills before the Senate Health and Welfare committee that would allow Governor Bill Lee to expand Medicaid (known as TennCare in Tennessee) with more freedom if he chose to do so.
One bill would have allowed Lee to do it. Another bill would have allowed Lee to do it without requiring a vote of the full legislature. Yarbro explained the bill was necessary to debate now because the issue is about the budget, is time sensitive, and is related to the COVID-19 pandemic. Tennessee General Assembly
Sen. Jeff Yarbro
He said expanding Medicaid could add about $1.4 billion into the state budget, would create jobs, would help hospitals here remain open, and that the state’s uninsured population of about 200,000 could swell to about 500,000 if the figure mirrors unemployment claims here since the virus arrived in March.
“I don’t think we should do nothing,” Yarbro said.
Senator Becky Massey (R-Knoxville) clarified that the bill would not compel Lee to expand Medicaid. Yarbro said it would not. The two then talked through the bureaucracy of actually expanding the program, and whether or not the state would have to receive a waiver from the Centers of Medicare and Medicaid Services (CMS).
[pullquote-1] Senator Bo Watson (R-Hixson) said the move to expand would come with added administrative costs. He worried doing it now would “create a financial challenge and add to the financial challenges we are facing.”
Yarbro said administrative price tags put on previous proposals were bloated with the “bells and whistles that we put in.” Also, an expansion could save money, he said, pointing to totally state-funded opioid abuse program that he said could be funded at 90 percent from the feds with a 10 percent state match. In all, he said expanding the program would have an economic stimulus “bigger than Amazon.”
But Yarbro said he knew the issue was politically complicated.
“I don’t understand, if we don’t do this … do we just punt?” he asked. “Have we concluded that the status quo is okay?”
In the end, both of Yarbro’s bills were sent to the committee’s general sub-committee, a sort of catch-all place where bills languish or die. Neither bill was considered with a vote.
Some time in the fall of 2017, when his gubernatorial candidacy was newish and his name identification across Tennessee was still in the birthing phase, Bill Lee issued what he billed as a 10-point “Commitment to Memphis and Shelby County.”
The points tended to the abstract rather than the concrete. Examples:
“— I commit that Memphis and Shelby County will play a significant role in our efforts to improve education, economic development, and enhancing public safety across West Tennessee.”
“— I commit to working with local leaders to find tailored solutions for the challenges of Memphis and Shelby County.”
“— I commit to a regional approach for economic development that ensures West Tennessee is competitive with Arkansas & Mississippi.”
Obviously, these — and others like them in the list of 10 — were fine objectives; just as obviously, they were nonspecific in the extreme, not the detailed and localized prescriptions that the Franklin businessman’s campaign billed them as.
The week of “State of the State” addresses just completed by Lee, now the governor, appears to reinforce the same impression of blanks needing to be filled in.
A case in point was the last of the three, billed as a “State of West Tennessee” address in a ballroom at the University of Memphis on Thursday evening, in the wake of the governor’s traditional “State of the State” address at the Capitol on Monday and a “State of East Tennessee” address in Knoxville on Tuesday.
[pullquote-3] Assuming the Knoxville speech followed the same outlines as the one in Memphis, it would have been more accurate to characterize the two outlier occasions as mere repetitions of the Monday night address in Knoxville and Memphis. In any case, the latter contained no new content and no expressly localized references at all, unless one counts Lee’s courtesy acknowledgements of dignitaries present before he settled into his remarks. (And even these acknowledgements, with few exceptions, were highly generalized within a request that “all elected officials” stand and be recognized.)
What followed the small talk and a brief statement of commiseration with area victims of flooding from the nonstop recent rains, was the same recollection of mountain-climbing in the Grand Tetons with daughter Jessica that had begun the speech to the gathered legislators and the state broadcasting networks on Monday.
The speech ended the same way as well, with a rumination on the moment that Lee and his daughter were inching their way along a mountain ledge high above an abyss below, with an intense awareness that looking back or looking down would be perilous in the extreme and potentially ruinous. As in Nashville, and presumably in Knoxville as well, this became a metaphorical exhortation for the state’s citizens and its government leaders as their exemplars to keep their attention focused, not on doubts or misgivings, but on the end goal of the climb upward — in Tennessee’s case, to lead the nation, as Lee would have it.
[pullquote-2] And that goal — or, rather, those goals were the same ones enumerated in the State of the State on Monday — worthy ones, for the most part, though the governor’s somewhat Trumpian pledge to be “unapologetic” regarding “American exceptionalism” doesn’t sound any less jingoistic or worrisome on second or third hearing.
The heart of the “State of West Tennessee” address was as word-for-word with the Nashville original as can be imagined — though a mite condensed here and there. The same points and the same categories were recapped — an educational system featuring parental “choice” and synchronization with the needs of “job creators;” a criminal justice system balancing “swift and severe” punishment for the violent and unredeemable with compassion and re-entry assistance for the non-violent; “high quality health care” (without need for Medicaid expansion, though that aspect remained unspoken); and a cost-effective government.
As before the GOP supermajority in the Capitol, the speech was punctuated with designated applause points — “designated” in the literal sense that a member of the governor’s entourage would get them started (or try to) by extra-loud clapping from the back of the hall in case, say, the Memphis attendees did not grasp on their own, the promised glory of there coming to pass a state rainy-day fund of $1.1 billion, “highest in the state’s history.”
All these deja-vu aspects were noted by the frustrated members of a local media queue as they awaited the governor’s appearance, post-address, in a side room of the ballroom floor. Surely, they reasoned, this was the time to pin him down.
And try they did. First question was a wonky one inquiring about the mechanics of Lee’s proposals for stepping up the role of charter schools. Could he elaborate? “We’re looking to create an authorization — a state authorization that would make it easier to open up good charter schools and easier to close those that are not performing,” said Lee, which was close to his exact words in the speech.
Earlier on the very day of his speech, the state House had passed the controversial “fetal heartbeat” bill. Would he sign it? “I have said and would continue to say that I would support legislation that lowers the number of abortions in the state.”
How, in the absence of Medicaid expansion, could the state ensure the solvency of its hospitals and the accessibility of medical care? “The best way to insure the quality of health care is to lower costs.” And a few more words to that effect.
One reporter was puzzled that a speech purporting to discuss the state of things in West Tennessee, had failed to make a single mention of the sprawling and (some thought scandalously) incomplete 174-acre industrial mega-site along the borders of Haywood and Fayette counties. Just under $200 million in state funds had been expended on the site so far, with an estimated $100 million yet to come. And no serious nibbles to date from potential “job creators” of the big-ticket variety or otherwise. What were the governor’s thoughts?
“I have a lot of thoughts about it. I have met with the folks in that region a couple of times now, and at our cabinet level we are focused on how we can best utilize the mega-site. I believe we ought to have it ready, we need to pursue a tenant for it, and that will be a focus and a priority of ours.”
Why has he taken a position against decriminalization of marijuana? “I think that would not be good for our state.”
[pullquote-1] What did he have to say about the state’s numerous potentially divisive racial issues? “There’s more that unites us than divides us.”
Those were the kernels of the governor’s responses. In fairness, he expanded on a few of them but not to any degree of real elaboration. Over and over, he would beg a question, or ignore it, or find a way to restate it. This has, rather famously, been the pattern as well of his interchanges with Capitol Hill reporters.
It was also the manner of his gubernatorial campaign. As was the case then, Lee has adopted a policy as governor of letting bromides, generalities, and talking points do his speaking for him. That was a helpful tactic during the campaign, when all he needed to do was to be the last man standing. It is arguably less so now, when he is the only one left to guide the state across the treacherous mountain ledge of its future.
With the 2017 legislative session just three months away, Democratic leaders in the General Asembly have made it clear that they are in no mood to accept the healthcare compromise offered up by House Speaker Beth Harwell’s task force on the subject.
That plan, which is sure to be the subject of debate when the legislature convenes, is a much-winnowed-down and highly-conditioned version of Governor Bill Haslam’s ill-fated Insure Tennessee proposal, first introduced during a special session in 2014 and bottled up by a Republican super-majority then JB
Rep. Craig Fitzhugh (D-Ripley), at Wednesday’s TNA forum, talks things over with District 96 House candidate Dwayne Thompson (center) and Thompson campaign adviser Bret Thompson.
and in another try since.
In a forum on state and federal legislation held Thursday night by the Tennessee Nurses Association at Jason’s Deli on Poplar, both state Senate Democratic leader Lee Harris of Memphis and House Democratic leader Craig Fitzhugh of Ripley denounced the would-be substitute plan presented by the Harwell task force, which bears the name “3 Star Health Insurance Pilot,” in the process renaming it. Their name for it? “Hooey!”
Instead of providing expanded Medicaid coverage for all Tennesseans currently uncovered by health insurance, this plan would, during a two-year trial period, offer coverage to uninsured veterans and people suffering from mental health needs, withholding any larger coverage pending a legislative re-evaluation that would include an opportunity to suspend the plan altogether through a variety of “circuit breakers.”
Harris drew first blood when asked about the task force plan: “Beth Harwell’s proposal sounds like a bunch of hooey to me. On our side of the aisle we are still pushing for expanded Medicaid in the form of Insure Tennessee or a similar alternative.”
Harris described Insure Tennessee as “the best way to take care broadly of a population that’s uninsured and [of] hospitals around our state that are suffering under financial strain and some of which are completely out of business.”
Insure Tennessee never got a fair consideration, Harris said, because “Republican party chairmen from around the state wrote in to Republican legislators and said ‘you better not consider Obamacare.’” Harris said the current “meltdown” in Republican politics caused by the internal party strive over Donald Trump’s presidential candidacy afforded Insure Tennessee a better chance of passage. In any case, “we don’t have to react to a bunch of hooey.”
Those remarks were basically seconded by Fitzhugh, who repeated the epithet: “This 3-start hooey is a bad idea.” Fitzhugh said “the worst part” of the task force proposal is that, instead of the 9 to 1 federal to state match proposed by Insure Tennessee, “in this 3-star plan it is only a 2-to-1 match, and the numbers aren’t going to work out. It’s going to be expensive to the state, and then they’re going to start crowing about what happened when we expanded Medicaid and the state did it on their own and almost sunk our ship.’”
Fitzhugh also drew attention to the fact that the state, under the 3-star plan, could continue to be denied the $1.5 billion in annual federal funding it would draw under Insure Tennessee. “The only upside” of the task force plan is that it would “keep the issue alive,” Fitzhugh said.
Two Democratic candidates for the House — Dwayne Thompson, running against incumbent Republican Steve McManus in District 96, referred to the task force plan as a rudimentary program…Obamacare Very Light” and said “my opponent bottled [Insure Tennessee] up in committee.
Thompson indicated that, if elected, he would attempt to amend the task force plan so as to broaden its coverage if Insure Tennessee itself could not be considered. He was seconded in that respect by Democratic candidate Larry Pivnick, running against incumbent GOP Rep. Mark White in District 83. “If they offer the compromise bill first I’ll move to amend it to include everybody. We have to call the question.”
Mark Lovell, unopposed after defeating incumbent Curry Todd in District 95, and the only Republican in attendance who was running for a state position, commented that he himself was “fortunate to be able to buy my own health insurance,” but said he thought the task force plan would “fix a huge void” and that “we should do whatever we have to do to take care of certain other people. We all need to make sacrifices.”
Remember the old saw, “It takes money to make money”? That’s a classic, right up there with, “The Lord helps those who help themselves,” which makes the same kind of sense. The idea behind both sayings is that all good
results have to be seeded in advance from somewhere, somehow. Merely consider turning those two chestnuts upside down: “It takes the absence of money to make money;” “The Lord helps those who decline to help themselves,” and you get instant nonsense. Or at least fodder for debate.
And the same insight applies to some of the other standard proverbs. Such as, “Mighty oaks from little acorns grow.” You gotta have the acorns to start with, of course.
This principle — call it “priming the pump” — came to mind this week when we read that the federal government is going to try to reclaim from the city of Memphis some $3.8 million that it advanced the city to build an automobile inspection station off Appling in East Memphis. That’s the amount that was advanced by the feds under an air-quality initiative to build a facility that cost a total of $6 million to construct. That’s real American money, nothing theoretical about it, and, unless our various representatives in the state and federal government can work out some swaps or pro rata reductions that will take the city wholly or partly off the hook, it will take … $3.8 million to pay the money back.
That’s dead loss, and if you start to consider some of the intangibles involved in the affair, you begin to realize that it’s more than likely that the abolition of the testing station on Appling and the others that the city used to operate will already have resulted in various damages to the ecology and urban infrastructure in undetected air pollution, a greater incidence in traffic accidents and fatalities, and work-time lost from unanticipated glitches in people’s personal transportation.
A similar loss has afflicted the city with the departure of an estimated 300 to 400 first-responders who have resigned, due to a loss of or decrease in their health benefits as a result of budget cuts undertaken by the mayor and city council over the last couple of years.
Mayor-elect Jim Strickland made it a chief plank in his electoral platform to reinforce public safety, so as to make Memphis a desirable place to live and work, and to stabilize and stop the drain of people and resources from the area. But as councilman, Strickland had been among those advocating and voting for the cuts in benefits. Now the circle has come full and the problem is back in his mayoral lap. To which, we say, good luck, Jim!
We’re not even going to get started on the abysmal cost to the state of Tennessee — hundreds of millions of dollars, plus lives lost, health ruined, and hospitals shuttered — as a result of the state government’s refusal to accept Medicaid-expansion. The sheer moral and fiscal irresponsibility of that folly continues to counter all human logic.
But, so be it. Can we be penny foolish and pound foolish at the same time? The answer appears to be yes. Oh, well, Happy Thanksgiving, all the same!
No one can say that we were lax in urging Governor Bill Haslam to find some way to come to terms with the Affordable Care Act (ACA). Tennessee, with its large lower-income population and a financially threatened hospital network, needs to take advantage of the billion or so federal dollars that come annually with Medicaid expansion.
Had the Governor made his peace early on with the ACA (or Obamacare, as Republicans prefer to call it), he might have been able to get his plan across in quick order and relatively uncomplicated fashion. He chose to procrastinate, however, possibly to keep the restive Tea Party component in the Republican-dominated legislature at bay. He proclaimed the existence of something called “The Tennessee Plan,” which, he said, was in the process of creation and which, when complete, would form the basis of a waiver request with the Department of Health and Human Services.
We would later learn that there was — at that time — no such plan, not even much of a skeleton for it. And meanwhile the GOP majority, goaded on by determined ultra-conservative foes of Medicaid expansion (and perhaps even of Medicaid itself) like Germantown state Senator Brian Kelsey, took advantage of the delay to pass legislation that requires approval by both houses of the General Assembly for any state involvement whatsoever with the ACA.
Haslam, it seemed, had put himself — and the state, especially its working poor and its medical providers — in a box from which there was no escape.
Well, who is to say that the age of miracles has passed? The governor, at length, did come up with a plan called “Tennessee Promise,” with a two-track modus operandi that would allow participants either to accept vouchers for use with private insurors or to come within TennCare (Tennessee’s version of Medicaid) with an obligation to make modest co-pays and premium payments. It seemed a genuine compromise between the ideology of the marketplace and governmental intervention to meet an obvious social need.
And Haslam’s plan possesses a “fail-safe” provision that allows for automatic discontinuation of the state’s program in case of default by either the federal government, which promises to provide 90 percent of funding after the first two (fully paid) years or the Tennessee Hospital Association, which has pledged to take care of the remaining 10 percent.
This last provision should have invalidated the oft-expressed doubts by critics of Medicaid expansion in Tennessee that the state would veer into ultimate insolvency by committing itself to the federal funding, but it hasn’t. The critics have merely shifted ground a bit, crying rhetorical crocodile tears and claiming that either the feds or the Hospital Association or both will weasel out in two years’ time and leave the impoverished masses once again without coverage.
To call this claim “disingenuous” is to give it too much credit. The population on which this bogus concern is lavished is without coverage now. Even in the critics’ implausible scenario, something now is far better than nothing, ever.
All sophistries aside, Haslam’s plan is entitled to full and bipartisan support in the February 2nd special session. We urge its passage, the sooner the better.
Tennessee General Assembly 
JB 
