Tag: Obamacare

Categories
Opinion Viewpoint

Fixing the Lines

This week marks the 271st birthday of the politician who first approved of “gerrymandering.” As governor of Massachusetts, Elbridge Gerry (also the nation’s fifth vice president) agreed to the idea of drawing congressional districts in odd shapes to ensure that the political party in power won the majority of the state’s seats in the House. His enduring legacy is the partisan split in Congress that dismisses compromise and disdains bipartisan solutions to the nation’s biggest problems.

But last month, the Supreme Court took a first step toward burying the corruption of gerrymandering. In a 5-4 decision, the justices approved of voters deciding by referendum to create independent, nonpartisan commissions to draw a state’s congressional map. Last week, the Florida Supreme Court followed up by ruling that parts of a current redistricting plan violate the state constitution by being crassly political.

Justice Ruth Bader Ginsburg’s majority opinion said voters have the right to go around politically skewed state legislatures and “address the problem of partisan gerrymandering — the drawing of legislative district lines to subordinate adherents of one political party and entrench a rival party in power.”

“Entrench” is the right word. One popular joke around Washington is that redistricting by state legislatures allows members of Congress to pick their voters instead of voters picking their members of Congress.

When it comes to 2016 House races, more than 400 of the 435 seats in the House are rated as “safe” for incumbent Republicans and Democrats because of gerrymandering. That leaves only about seven percent of the seats in Congress open to a meaningful contest.

Gerrymandering has distorted congressional politics by eliminating the need for either party to appeal to the political middle. Instead, the members of Congress live in fear of a challenge from the far right (in the case of Republicans) or the far left (in the case of Democrats).

Gerrymandering is the mother of the “Tea Party Caucus” that undermines the Speaker, John Boehner (R-Ohio), by denigrating him as insufficiently conservative when he tries to make budget deals with Democrats.

Gerrymandering is the reason President Obama tells supporters the best thing they can do to help him is to move to a red state and help break the GOP hold on Congress.

In the 2014 cycle, an off-year election, Republicans had the edge in voter enthusiasm as well as control of more state legislatures. As a result of the power of gerrymandering, the GOP won 57 percent of all House seats even though they had just 52 percent of the votes.

Even in election years when majority control of the House changes from one party to the other, the reelection rate tied to gerrymandered districts is staggeringly high. In 2006, when Democrats won the House, 94 percent of incumbents were reelected. In 2010, when Republicans rode a Tea Party wave back to the majority, 85 percent of representatives retained their seat. This is the politics of back-room congressional mapping.

This era of unprecedented polarization and dysfunction borne of gerrymandering has current congressional approval ratings down to 15.8 percent, according to the RealClearPolitics polling average. Obviously, Republicans as well as Democrats disapprove of what is going on in this broken Congress.

Senator John McCain has often said that the only people approving of Congress these days are “paid staffers and blood relatives.”

The adoption of independent state commissions to draw congressional maps is by far the most important step available to voters longing for a Congress that works. Seven states already have nonpartisan commissions in place: Arizona, California, Hawaii, Idaho, Montana, New Jersey, and Washington state. With the Supreme Court’s recent ruling, the door is open to more. It is not as sexy as the court’s recent rulings on gay marriage and Obamacare, but this high court ruling also has historic potential. It opens the door for voters in more states to get referendums on the ballot calling for nonpartisan panels to set the lines for congressional districts — and so revive a functional Congress.

Juan Williams is an author and political analyst for Fox News Channel.

Categories
News News Feature

A Week of Change

In a week of monumental events signaling — and legally upholding — transformational change in America, my imagination was drawn to a 21-year-old man-child sitting in an isolated jail cell in Charleston, South Carolina. What must admitted mass murderer Dylann Roof be thinking, I wondered. He set out to tear apart, through one heinous and violent act, the moral fabric of this democratic republic established nearly 239 years ago. He is not the first to try — and fail — to do so, and he won’t be the last.

What Roof missed — now that he’s just another misguided, murderous idiot behind bars — was hearing the resounding echoes of social and economic triumph two United States Supreme Court rulings finally addressed in declarative fashion. What Roof missed was a president of the United States rising to oratorical heights in a speech meant to speed the healing process surrounding the pain, anger, and disillusionment Roof’s act of racial intolerance created. He missed the inspiring words that celebrated the resiliency of our country in times of unspeakable tragedy. He missed “Amazing Grace.”

In his incarcerated absence, Roof may have been unaware of the high court’s solid majority vote upholding the legality of the Affordable Care Act. For millions of people in this country, including thousands in Tennessee, the fight to insure the poor, the elderly, and those on the borderline of a healthy existence will continue. They will have new paths toward being able to secure medical treatment for afflictions and diseases that otherwise would have sentenced them to lives of pain or unneccessarily premature death. Unfortunately, the SCOTUS decision on Obamacare by no means ends the political opposition to it, but it gives legal clarity to what is an earnest attempt to level the health-care playing field for the haves and have-nots.

The same antagonistic forces that have long opposed “Obamacare” have vowed to continue to seek a constitutional amendment overturning the court’s ruling. Word to the wise: Barring more conservative appointments to the high court, an unlikely prospect, that ship has sailed.

Roof, in the personal “manifesto” that surfaced after his arrest, expressed his loathing for African Americans, Latinos, and Jews. Oddly, none of his hate-filled rants targeted gays or same-sex marriage. Not that Roof will be in a position to witness such unions, but that issue was also addressed by the Supreme Court last week, and the court struck down barriers against gay marriage instituted by state governments. The majority decision used the words “human dignity” — a number of times — to bolster its judicial opinion. The same phrase was often used by abolitionists in arguing against the evils of slavery.

While young Mr. Roof rots in prison awaiting his likely execution, he will find plenty of the kind of seething anger and racial and sexual intolerance he had hoped to ignite by sparking a race war. He will have plenty of time to ponder how his cowardly and pathetic actions served as a sad precursor to what became a magnificent week in American history.

I hope he will agonize about the hour he spent inside the Emanuel African Methodist Episcopal Church — a Judas in the House of the Lord. I hope the parishioners’ words of prayer and forgiveness that he heard while plotting his mayhem will be seared in his memory for whatever time he has left on this earth.

Mr. Roof, you picked the wrong place, the wrong time, and the wrong people. You failed.

And as long as the United States remains strong enough to tolerate dissent and disagreement, as long as “we the people” are willing to listen to opposing opinions about the issues that divide us, as long as we recognize injustice and fight to right the wrongs that befall the least of us, then people like Dylann Roof will be forgotten footnotes in the great American story.

As a nation, we are a work in progress, an ongoing saga of success and failure, where perfection will never be achieved. But last week demonstrated we’re still valiantly searching for it.

Categories
Editorial Opinion

Tennessee Report Cards

Ours is an age when “outcome-based” is increasingly attached to public-policy initiatives and testing of various sorts is very much in vogue, not only in education but as a measure of success or failure in other ways as well.

This week, Tennesseans can consult brand-new studies to see how the state is doing in K-12 public education and how it could be doing in health care.

First, a freshly released Rutgers University study, entitled “National Report,” grades the 50 states on the extent of their financial commitment to public education. At a time when officials of the Haslam administration and the governor himself cite various other studies as proof of the success of their education initiatives, the Rutgers report tells another story.

While the report awards Tennessee a “B” for the equity of its fund distribution — i.e., in giving poor districts a fair share of the financial pie — it gives the state a flat-out “F” in determining the size of the funding pie itself. 

In measuring teacher compensation against pay for other vocations in the labor market, for example, the report has this to say: “Wages are least competitive in Missouri, North Carolina, Arizona, Georgia, Tennessee, and Virginia, where teachers make around 30 percent less. Wage competitiveness worsens as teachers advance in their career.”

Keeping in mind that the ability of Tennessee’s teachers to change their economic lot for the better was undermined by the General Assembly’s abolition of their collective-bargaining rights in 2011, a long-term improvement would seem to be disproportionately dependent on the good will of state political authorities.  

On the issue of health care, a couple of reports issued during the past week by the White House eschew the course of fault-finding with Tennessee per se in favor of underscoring what the state is giving up by its failure to participate fully in the benefits of the Affordable Care Act (ACA).

What the White House makes clear in a “Fact Sheet” released this week is that Tennessee — despite itself, frankly — is reaping enormous advantages already from the ACA. These include the reduction of insurance premiums for participating Tennesseans, the elimination of out-of-pocket expenses for a variety of testing and screening procedures, the prohibition of “pre-existing illness” restrictions, and the elimination of the infamous “donut hole,” whereby Medicare prescription benefits disappeared at a certain level.

That and more constitute the high side. But what the two White House reports also make clear is that, by declining to follow through on Haslam’s proposed “Insure Tennessee” program, the General Assembly has doomed the state to an annual loss of $1.77 million in ACA Medicaid funding for health care, and to the relegation of 180,000 uninsured Tennesseans to the kind of emergency-room care that has proved ruinously expensive to the state’s over-burdened hospitals. 

The White House issued no grades as such for Tennessee state government’s performance in providing health-care opportunities on its own or in taking advantage of those provided by the federal government, but it seems clear that, at best, the state has earned an Incomplete and, at worst, another “F.”

Failing grades in education and health care? Those are unacceptable report cards.

Categories
Opinion Viewpoint

Killing the ACA?

For Republicans, it sure was fun while their hopes lasted, but many have concluded the Supreme Court might not be able to kill off the Affordable Care Act (ACA) after all.

When the high court rules this spring in King v. Burwell, even a decision that would invalidate subsidies to cover health insurance in 37 states where the federal government operates exchanges may not necessarily spell doom for those subsidies or the system at all. 

Republicans are already anticipating President Obama’s response would be an executive order directing federal marketplaces to immediately belong to those states or a bill asking Congress to do the same, or at least to extend the subsidies in some form. 

Somewhere between 5 million and 7 million people, many from Republican states that refused to start exchanges, will be at risk of price hikes that could eventually torpedo the entire law. The GOP is scrambling for an appropriate response as a new Kaiser Family Foundation poll shows, in the case of a ruling against the law, that 64 percent of Americans want Congress to extend subsidies in affected states — including 40 percent of Republican respondents.

Over time, ObamaCare has morphed into a zombie Republicans cannot extinguish. 

First, there were the angry town halls in August of 2009, but then the bill passed in March of 2010. 

There was a historic, nationwide victory for Republicans in the midterm elections of 2010, resulting largely from antipathy toward ObamaCare. 

Then, to conservatives’ horror, in June 2012, the Supreme Court ruled that the taxes in the ACA were constitutional, with the deciding vote of Chief Justice John Roberts. 

Then, when there was hope of electing a GOP president to repeal the law, the party nominated someone who had created the very model for the law in Massachusetts and wouldn’t denounce it, and Obama was reelected in 2012. 

Now, Republicans have expanded their majority in the House, taken control of the Senate for the first time in eight years, and the law faces a high court review that could obliterate its very structure. The Affordable Care Act’s approval, at 40-46 positive/negative, stinks. Yet the law, no matter the ruling in June, not only could survive, but it could subsequently be improved.

Conservatives on the far right, not surprisingly, are hoping for the insurance price death spiral should the court declare subsidies in federal exchanges illegal. Other Republicans say it would not be the responsibility of the Congress to provide any response, while still others say that preparing a thoughtful response that prevents chaos could actually smooth the way for a majority of the nine justices to rule against the subsidies.

Some Republicans describe it as the last chance for the undoing of the ACA. In order to force it into the 2016 presidential debate, one option would be the extension of subsidies that would sunset in late 2017, in order for a new president and a new Congress to fix it again or repeal it. For an extension, Republicans would want concessions like reinstating the 40-hour work week and eliminating both the employer and individual mandates.

But cajoling 13 Democrats in the Senate to override a veto seems far from likely. So does refusing to extend subsidies, because millions of those possibly affected are from red states Republicans represent or blue ones they want to keep or win. The 56th vote in the House to repeal the ACA saw three new GOP defections, from Republicans in swing districts. States potentially affected by the King v. Burwell decision include 2016 battlegrounds like Florida, North Carolina, Wisconsin, Pennsylvania, and Ohio. There are Republican senators running for reelection two years from now in all five.

Five years after passage, ObamaCare is a paradox. It’s deeply unpopular — but just not enough to destroy it.

(Bryce Ashby is a Memphis-based attorney and board chair at Latino Memphis, Inc.; Michael J. LaRosa is an associate professor of history at Rhodes College.)

Categories
Letters To The Editor Opinion

What They Said (February 12, 2015) …

CREDIT: Greg Cravens

Greg Cravens

About Jackson Baker’s post, “Haslam’s Medicaid Expansion Bill “Hanging by a Thread” …

Kelsey is a fool, a traitor, and a moron! The trifecta, as it were.

Tennessee Waltzer

The majority of people opposed to Insure Tennessee are the Tea Partiers in our legislature. Most Tennesseeans favor the program. And Brian Kelsey should hang his head in shame for being part of the taxpayer-funded state health insurance program while denying the same to the working poor of Tennessee.

Jenna Sais Quoi

It’s dangerous having someone with Kelsey’s mindset — more loyal to his narrow ideology than to the well-being of the people of Tennessee.

Concerned in Shelby County

We have someone as president who is 100 times more dangerous with his own narrow ideology and use of executive orders to bypass Congress.

Firefox

You couldn’t be talking about the current president, who has signed fewer executive orders than all presidents since Grover Cleveland and uses Republican ideas like the ACA.

Concerned in Shelby County

I’ll just put this here: “Six of seven senators who shot down Insure Tennessee have state health care.” Hint: three of them are in this article, and the fourth one is our local idiot.

Charley Eppes

About Chris Davis’ Viewpoint, “‘Night, Darlin'” …

Poetic touching tribute. You paint a picture of a moment that many of us shared in our own way. Thanks for a beautiful private look into the way a kind soul can make a difference in many lives. Larger than life. Thank God.

Peter Ceren

To be inside the P&H after last call and the doors were locked was a cross between a return to the womb and breakfast at Valhalla.

CL Mullins

About Wendi C. Thomas’ column, “Thanks, Obama!”

I’m a Democrat who pays the Halls tax and federal taxes. Insuring others keeps my own personal health care less expensive because I’m not paying for anyone else’s unpaid bills.

I also have a pre-existing medical condition that prevented me from ever getting health care outside of an employer. Without insurance, I would be spending upwards of $15,000 a year staying alive and healthy. Since the health-care exchange opened, I have had a peace of mind that I have never enjoyed before in my adult life, because I have choices that extend beyond finding a job with top-notch insurance and going broke trying to stay alive.

CSH

Rural hospitals are closing all over Tennessee. When good, God-fearing, country folk start dying on the two-hour trip to the nearest hospital, there’ll be hell to pay … for Democrats, of course. Republicans will blame Obamacare.

Jeff

I was a conservative Republican when I was laid-off from my job in 2000. The ever-increasing cost of maintaining insurance via COBRA convinced me that socialized medicine is the way to go. I don’t mind my tax dollars supporting such a system, even though Obamacare isn’t such a system and doesn’t go nearly far enough toward socialized medicine.

Republicans lose their jobs as frequently and as easily as anyone else. And I just want to laugh at retired Republicans with Medicare who oppose Obamacare.

Brunetto Latini

To those who can understand the plight of the uninsured and support medical insurance for the least of our brethren and don’t fear to speak up about it — my hat is off to you!

Truth Be Told

I hope others are joining all good Republicans like myself in leaving this country if Obamacare continues. We shall find a civilized country without socialized medicine, like … uh … uh. I’ll have to get back to you, brothers. Hold off on the packing.

tnRepublican

Categories
Editorial Opinion

Haslam’s “Good Faith” Issue

As chronicled elsewhere, Governor Bill Haslam began this week of legislative special session in Nashville with the challenge of persuading reluctant members of his Republican Party to suspend their aversion

to what they call Obamacare and accept his home-grown version of Medicaid expansion called Insure Tennessee.

Prior discussions of the matter in the media have focused almost entirely on the mechanics of the plan or the political matters at stake or the financial incentives available to Tennessee (and its hard-pressed hospitals) should the General Assembly opt to give its statutorily necessary approval to the proposal. Those financial stakes are large indeed, amounting to somewhere between $1 billion and $2 billion annually. But the political obstacles are large, as well: GOP talking points against Obamacare (the vernacular name for the Affordable Care Act) are so well established that the governor’s arguments for Insure Tennessee had to be couched in terms that drew the broadest possible distinctions between his Tennessee variant and the federal act.

Accordingly, Haslam made much of marketplace methodologies embedded in Insure Tennessee — including an alternative plan-within-the-plan for vouchers to pay for private insurance, as well as requirements for co-pays and modest premiums for those new insurees opting for coverage under TennCare (Tennessee’s version of Medicaid). And the governor catered to home-state Republican sensitivities by adding an anecdote to his prepared speech involving his past entreaties to President Obama, along with those of other Republican governors, to allow Medicare funding to be dispensed to the states via block grants for the states to dispense as they wished.

But much of the governor’s speech was taken up, too, with appeals to the legislators’ hearts as well as to their heads. Opponents of Insure Tennessee have been shedding crocodile tears at the plan’s provision for discontinuing Insure Tennessee after two years if either the federal government or the Tennessee Hospital Association default on promised funding. That would drop thousands of new insurees from coverage, the critics say. To this, Haslam offered the common-sense rebuttal that two years of coverage are significantly better than no health-care coverage at all.

And he offered his listeners a real-world anecdote about a Tennessean whose stroke, resulting from his inability to afford health insurance, had “landed him in the hospital, followed by rehabilitation” and taken him out of the workforce. “He was a hard-working Tennessean who wasn’t able to get the care he needed on the front end and that has real consequences for him and his family. Having a stroke wasn’t only devastating to him and his family, it could have been prevented, and not preventing it is costly to all of us.”

The governor then, having argued facts and savings and marketplace models, laid the matter to rest on the bedrock issues of values and good will: “I think this is also an issue about who we are. My faith doesn’t allow me to walk on the other side of the road and ignore a need that can be met — particularly in this case, when the need is Tennesseans who have life-threatening situations without access to health care.”

Indeed. It’s a matter of good faith and we agree with the Governor: That’s the nub of the issue.

Categories
News News Feature

Thanks, Obama!

Last week, I joined the nine-million-plus Americans who have Obamacare.

My premiums are less than I paid with employer-sponsored health insurance, my deductible went from $2,800 to zero, and I can stick with the same primary care doctor.

Thanks, President Obama!

The opportunity to have affordable health insurance separate from a job allows me and many others to pursue more meaningful work. For the first time in my life, I can explore being not just an employee but an entrepreneur. (Or as Mitt Romney would say, a maker, not a taker.)

Nearly five years after the Affordable Care Act was signed into law and after months of dithering over whether to get on board, Governor Bill Haslam has come up with Insure Tennessee, his too-little-too-late version of Obamacare.

Of course, Haslam would never call it that. But without Obamacare, it’s unlikely that the nation’s richest politician (net worth: $2 billion) would have devised a health insurance plan for the working poor.

Thanks again, Obama!

On Monday, Haslam convened a special session of the state legislature to consider Insure Tennessee. The two-year pilot of Insure Tennessee wouldn’t start until 2016. That means the state would forfeit even more than the $2.4 billion it’s passed up so far by refusing to accept federal dollars for Medicaid expansion, which was a key part of the Affordable Care Act.

Insure Tennessee is aimed at those who earn less than 138 percent of the federal poverty level, or $16,242 for an individual. Haslam’s administration estimates that 200,000 Tennesseans would be eligible for Insure Tennessee.

Even if I stood to benefit, I wouldn’t be impressed.

Said Haslam when he announced his plan: “This plan leverages federal dollars to provide health-care coverage to more Tennesseans, to give people a choice in their coverage, and to address the cost of health care, better health outcomes, and personal responsibility.”

See that last part about personal responsibility? If you thought Haslam was motivated by any Christian obligation to be his brother’s (or sister’s) keeper, those two words should disabuse you of that notion. This right-wing blather about personal responsibility is a smokescreen, part of a nasty narrative that falsely insists those who accept government assistance or subsidies in any way are reckless ne’er do wells.

The Robert Wood Johnson Foundation estimates that expanding Medicaid would cost Tennessee $1.7 billion over 10 years, most of which would come after 2017, when the federal government’s contribution drops to 95 percent, then 94 percent in 2018, 93 percent in 2019, and 90 percent from 2020 on.

Under Insure Tennessee, state hospitals would cover that 10 percent gap. Not out of the goodness of their hearts, but because patients with insurance mean more money for hospitals.

But here’s something you should know. According to a New York Times analysis, Tennessee spends at least $1.58 billion each year on incentives for businesses. That’s right, Tennessee would spend far, far less on health care for the working poor than it does on tax incentives, sales tax refunds, and corporate income tax reductions to lure companies to the state. If corporations are indeed people, then Haslam is the most compassionate man on the planet.

But if people are people — including the 918 lives that would have been saved in 2014 with Medicaid expansion — then the refusal to embrace Obamacare is cruel, mean-spirited, and immoral.

It is unconscionable that, just now, Haslam’s administration will give to Tennesseans the care and attention it’s been giving to businesses for years.

But with a Republican governor and a Republican-controlled state house and senate, Insure Tennessee is the best we will get — and it’s far from certain that the legislature’s Tea Party contingent, which is virulently anti-Obama anything, will support it.

Open enrollment for Obamacare continues through February 15th. If you don’t enroll by February 15th, you probably won’t be able to get insurance through the federal exchange this year, unless you get married, have a child, lose a job, or experience some other qualifying life event.

Go to getcoveredtenn.org to schedule an appointment with an enrollment counselor who can walk you through the process.

And once you’re enrolled, you know who to thank.

Categories
Politics Politics Feature

Sentiment Divided on “Insure Tennessee”

NASHVILLE — Like his 11-minute re-inauguration speech delivered two weeks ago, Governor Bill Haslam’s 15-minute opening address Monday night to this week’s special session on Insure Tennessee, his Medicaid expansion plan, was brief and to the point and couched in accommodationist rhetoric.

The previous speech had no particular mission in mind other than to hint at a more assertive second term: “[W]e haven’t had nearly high enough expectations of ourselves. In many ways, we’ve settled and haven’t lived up to our full potential. So one thing I can guarantee you that we are not going to do in the next four years is coast to the finish line.” But Monday night’s address was designed to spell out a key resolve that could be crucial to the success or failure of that race to the finish line.

The good news, from the governor’s point of view, was the prolonged standing ovation he received upon entering the chamber Monday night — a sign of the general good will that the General Assembly, on both sides of the political aisle, continues to extend to Haslam.

The bad news, from Haslam’s point of view, was that, by general agreement, he still has — in the words of state Representative Glen Casada (R-Franklin), who has been a prominent opponent of  the governor’s plan — “his work cut out for him.” Said Casada about House prospects: “He needs 50 out of 99, and right now he doesn’t have it.”

That outlook was echoed by state Representative Craig Fitzhugh (D-Ripley), the Democrats’ House leader and a firm supporter of Insure Tennessee. Fitzhugh said, “He answered the questions. The main questions my friends on the Republican side have had. … The Republican caucus needs to show they have a concern for ‘the least of these’.'” The plan had “no downside,” said Fitzhugh, but, “I think he’s got a lot of work to do.”

State Senator Brian Kelsey (R-Germantown), chairman of the Senate Judiciary Committee and a foe, not just of the governor’s plan but of Medicaid expansion in general, said he thought opposition to Insure Tennessee was “mounting, the more we hear about it.”

Referencing a point Haslam had extemporized into his prepared remarks, to the effect that Republican governors had persistently expressed a wish to President Obama that Medicaid funding be presented to the states in the form of block grants, and that Insure Tennessee came close to that goal, Kelsey said, “My takeaway is this: The governor and I agree that we’d love to have a block grant in Tennessee, but that’s not what the president is offering.”

There were, however, signs that a bipartisan support coalition of Insure Tennessee from Republicans and Democrats (a distinct minority in the legislature that Haslam, however, had made a point of courting) might be possible.

In the immediate aftermath of the governor’s speech, state Rep. Antonio Parkinson, a Memphis Democrat, and state Rep. Mark White, a Republican who represents East Memphis and the suburbs, agreed that Haslam had made enough distinctions between Insure Tennessee and the Affordable Care Act (Obamacare) to coax reluctant GOP members to support the plan.

White himself had been one of those GOP members who’d been biding his time but now expressed support.”I think that was important for him to distance himself from the president,” White said. “He also gave a personal side. It’s not all politics. … The more you weigh it on our measuring scale, it weighs out that we need to do something.”

Two Democrats differed on the role of their party in the debate over Insure Tennessee. State Senator Lee Harris, the former city council member who was elected by Senate Democrats (5 members out of 33) to be minority leader, said, “It’s not about the Democrats. It’s not newsworthy what the Democrats are doing. That’s irrelevant. It’s about the Republicans. They have control of both chambers. If you’ve got control, you’ve got responsibility.”

State Representative G.A. Hardaway, another Memphis Democrat, begged to differ. Of the 26 Democrats in the 99-member House of Representatives, Hardaway said, “We hold the key in the House.”

• In his Monday night address opening the week of special session, the governor — Haslam being Haslam, a man of soft persuasion rather than faustian and bombast — artfully pitched an appeal that was simultaneously above partisan politics and designed to address what have been the main sticking points among GOP legislators.

The governor dutifully paid lip service to Republican talking points, loosing his own shots at what he consistently called Obamacare but taking pains to distinguish his own plan from the superstructure of the Affordable Care Act.

Haslam gave an explanation for why, in 2013, he had rejected the opportunity to expand Medicaid (TennCare in Tennessee) — an expansion that would have allowed the state to avail itself of about $1.5 billion annually, money which the state’s hospitals, charged with caring for indigent patients, contended they desperately needed.

He hadn’t accepted expansion then, the governor said, because “expanding a broken program doesn’t make sense. … But I also didn’t think that flat-out saying no to accepting federal dollars that Tennesseans are paying for — that are going to other states, and that could cover more Tennesseans who truly need our help — I didn’t think that made much sense either.”

Accordingly, he said, he decided to provide his own example of how a governmental health-care plan should work, spending the time since that decision in 2013 to devise what he told the assembled legislators is a two-year pilot program that has incorporated free-market principles, both through an optional voucher component for use with private insurance plans and through requiring co-pays and modest premiums — “skin in the game” — of those new insurees who chose to go through TennCare.

Haslam pointed out that Insure Tennessee would add no new costs to the state budget, since the Tennessee Hospital Association (THA) had guaranteed to pay any additional costs incurred once the federal government, after two years, dropped its own subsidy from 100 to 90 percent.

If either the federal government or the THA proved unable to follow through as promised, or if the state in two years’ time decided Insure Tennessee wasn’t a good fit, the state had been assured by court decisions and the state attorney general’s advice that it could discontinue the plan.

(Pointedly, the governor, in giving the address, dropped this line from his prepared remarks: “I understand the concern, but I think it’s worthy of mention that the United States of America has never missed a scheduled Medicaid payment.”)

As for the professed concern of Insure Tennessee skeptics regarding the pain of having to discontinue coverage for new insurees after two years, Haslam said, “If you gave your loved one an option: You can have health coverage now to address your very real need and with that the possibility that you might lose it in the future, or you could never have it, which would you choose? If you think about your loved one, I bet the answer is simple.”

Ultimately, said Haslam, the state simply had an obligation to the unfortunate and the indigent, one based in commonly held spiritual precepts. “My faith doesn’t allow me to walk on the other side of the road and ignore a need that can be met — particularly in this case, when the need is Tennesseans who have life-threatening situations without access to health care.”

• Back in Memphis, pent-up controversy was also moving toward some overdue discussion. On Wednesday’s committee agenda of the Shelby County Commission is a call for open discussion of the future of the Economic Development Growth Engine (EDGE), which guides industrial and business expansion and awards economic incentives toward that end.

Republican member Steve Basar, chair of the commission’s economic development committee and the commission’s ex officio member of the 11-member EDGE board, placed the discussion item. Basar said he heard “rumblings” of discontent about EDGE on the commission, including possible calls for the board’s abolition, and, as an EDGE supporter, wanted to address it.

Much of the discontent was an adverse reaction to the EDGE board’s recent decisions on PILOTs (payment-in-lieu-of-taxes), but Basar said only minor modifications were needed.

Categories
Cover Feature News

Healthcare Showdown In Nashville!

CREDIT: Justin Fox Burks

Forget the elephant in the room. Where Tennessee state government is concerned, the elephant is the room. Republican sentiment in virtually every county in Tennessee, and in each of the state’s three grand divisions, is so overwhelming that all meaningful debates now take place within the GOP super-majority itself.  

As was the case during the multiple historic decades of Democratic domination, one-party government invites fragmentation, a process during which what appears monolithic and unified right now could well split into a right, a left, and a moderate center (all things being relative) as the political spectrum inevitably reasserts itself.

Something of the sort may get underway, in fact, as soon as next Tuesday, February 3rd, with the convening of the special session called by Governor Bill Haslam to deal with Insure Tennessee, the Republican governor’s home-grown version of a Medicaid expansion plan.

Justin Fox Burks

Mark Norris

Given the tensions and current disagreement on the subject within the GOP caucus, the session could easily last longer than the week allocated for it in the resolution authored (dutifully but reluctantly) by state Senate Majority Leader Mark Norris of Collierville. But not if Norris, an all-but-formally declared opponent of the plan, and the rabidly anti-Obamacare members of the Republican caucus have their way.

Although much of the declared and potential opposition to Insure Tennessee is clearly political, much of it, too, is either based on (or rationalized from) financial claims — one of them, certain to be heard early and often in the special session, being an allegation that the federal government could renege on its promise to provide 90 percent of funding for a state’s Medicaid program after fully funding the first two years.

Brian Kelsey

This is a favorite argument of state Senator Brian Kelsey (R-Germantown), a sworn foe of Insure Tennessee and of Medicaid expansion by any other name. “I question whether the federal government is a reliable negotiator,” said Kelsey last week, repeating an assertion he and other opponents make frequently — though not (so far, anyhow) with appropriate chapter-and-verse citations of prior derelictions by the feds.

Kelsey goes further, also questioning the validity of a commitment to foot the bill for the remaining 10 percent by the Tennessee Hospital Association, whose financially distressed and overburdened member institutions are desperate for the $1 to $2 billion that could be funneled annually via Insure Tennessee to TennCare (the state’s version of Medicaid).

The senator does not question the hospitals’ bona fides (though he has called the Hospital Association a “special interest”). Rather, he refers to a proposal periodically made in the past by U.S. Senator Bob Corker that would abolish the kind of fees on health-care providers that, as amplified in accordance with the Hospital Association’s pledge, could provide the association’s annual funding share.

A problem with that: Corker’s office responded to the claim with a statement that the senator had “no current plans” to proceed with any such legislation. Corker added, “I assume governors will continue to take advantage of federal laws as they exist today.”

In an indirect and gingerly fashion Corker made it necessary for critics of Insure Tennessee to challenge his own good faith on the matter.

Nevertheless, and despite the governor’s attempts to dissociate Insure Tennessee from Obamacare in information sessions (read: lobbying visits) held in Jackson and Memphis last week, it is a root fact that, in Tennessee as in Republican states elsewhere, the use of the president’s name in describing the Affordable Care Act (ACA) can by itself be a deal-killer.

It is that fact that prompted Haslam, earlier this month, to make a special appeal to the legislature’s Democrats for support of Insure Tennessee. With rare exceptions, if any, he should get his wish. But Democrats are a marginal factor in the General Assembly of 2105, owning only five seats in the 33-member state Senate and 26 of the 99 seats in the House.

The showdown over Insure Tennessee will be decided within the ranks of the legislature’s Republicans. In an interview with the Flyer two weeks ago, Norris contended that the GOP caucus was possessed of an “open mind” on the governor’s Medicaid proposal —and that he had not ruled out either opposing it or, as is the case with most administration bills, sponsoring it.

Yet it seemed obvious, in the thicket of reservations he expressed about the bill (most technical or procedural or fiscal, some philosophical) that Norris is disinclined to support Insure Tennessee. And, whether it was prepared with his cooperation or not, an online ad bearing Norris’ likeness and stating vigorous opposition to Insure Tennessee has been appearing with some regularity of late on various websites.

In his Flyer interview, Norris summed up several possible objections to Insure Tennessee: its effect upon ongoing litigation concerning TennCare in federal court; the specter of swelling TennCare’s rolls to the point of fiscal untenability; and uncertainty regarding what the U.S. Supreme Court will do in King v. Burwell, a case challenging the legality of federally administered health-care exchanges under the ACA.  

(Significantly, Norris is one of 18 members of the state Senate — a majority — who has signed on to an amicus brief on the plaintiff’s side in the latter case.)

All of this, Norris said, speaking of himself in his institutional role, constituted “the situation the majority leader has to deal with so as to instruct and inform my caucus,” adding meaningfully, “That’s the pool from which the governor has to draw for his votes. … My job is to maintain credibility with my caucus and to provide them with factual and legal information to make their best judgment.” 

The obligation to “maintain credibility” with his caucus had, up until that point, anyhow, kept Norris, in the case of Insure Tennessee, from assuming his normal role as sponsor of legislation desired by the governor.

Indeed, with less than a week to go before the onset of the special session, there is widespread doubt as to the form that action on Insure Tennessee should take.

“Is it legislation or a joint House-Senate resolution?” Norris wondered. “It could be a concurrent resolution, with two tracks [in the House and Senate separately and simultaneously].” In that case, Norris said, pointedly, “Any member can file amendments, including ‘poison pill’ amendments.” 

As Norris’ indicated, there has been a great deal of Alphonse-and-Gaston shuffling within the leadership ranks of the two chambers regarding who should bear the onus of formally presenting Insure Tennessee for consideration.

Jackson Baker

Speakers Ron Ramsey and Beth Harwell will play important roles in the Senate and House, respectively, during the special session.

Lieutenant Governor Ron Ramsey, the speaker of the state Senate, has indicated he is open to the idea of supporting Governor Haslam’s proposal, but he, like Norris, has professed uncertainty on the matter of procedure, suggesting that the House and Senate should act separately on the matter, with the House going first.

That hasn’t sat well with Norris’ opposite number in the House, Majority Leader Gerald McCormick (R-Chattanooga), who has braved the possible discontent of his fellow Republicans by endorsing Insure Tennessee and promising to do what he can to get it passed.

Calling the idea of a go-it-alone process in the House “preposterous,” McCormick said, “If they [Senate leaders] don’t want to do it, then they just need to tell us and we’ll go about our business and go into regular session. But we’re not going to go through an exercise in futility if they’re not serious about considering this legislation.”  

McCormick has been frank in declaring that House votes for Insure Tennessee may be hard to come by.

As quoted in the Tennessean two weeks ago,  McCormick put the issue succinctly, “It’s a government program and we’re expanding it. And as Republicans, we don’t like to expand government programs, period. But then you go back to the common-sense part of this … really the only practical way to provide these services … is to expand the Medicaid program.”

The debate in GOP ranks calls to mind the situation that another Republican governor in recent times found himself. The proactive way in which a term-limited Haslam has begun his second and final four-term term is reminiscent of the situation that former Governor Don Sundquist found himself in, circa 1997.

As is the case with Haslam, Sundquist confronted a gap between perceived policy needs and the revenues necessary for the state to act upon them. The ever-burgeoning rolls of TennCare, a program Sundquist resolved to support, were a part of the problem, but there was, at least in the then-governor’s mind, a structural weakness in the state’s revenue base that retarded other policy initiatives, as well.

The problem, as Sundquist saw it, lay in the inherent limitations of the state’s reliance on sales tax revenues, which, by definition, were subject to economic cycles. There was another problem, too: the inherently regressive nature of a sales tax. 

As Sundquist put it in 2011 in an interview with this writer for an article in Memphis Magazine: “Nobody disagrees that we ought to be a low-tax state, but we have to have a fair-tax system that is not regressive, and when you’ve got the people who make the least amount of money paying sales tax on food and clothing, it’s not fair. Then you’ve got all these professionals who are paying virtually nothing. Oh, they’ll tell you, ‘We pay a tax, a fee for our licenses.’ Just bull!”

Sundquist’s first solution back then was a proposal for a business tax, but, as opposition to that proposal grew, most of it from his own Republican ranks, he bit the bullet and proposed what he called a “flat tax” on income — one that would be offset by corresponding decreases in one’s federal income tax and could not be raised except by two-thirds majorities of both the state House and the state Senate.

Sundquist had Republican loyalists willing to back his proposal but not nearly enough to stem the tide of discontent, not only in GOP legislative ranks, but at the grass-roots level. The “I.T.,” as opponents of a state income tax derisively called it, was finally dropped from legislative consideration, on the very brink of passage, in the wake of a July 2001 riot on the state capitol grounds by what numerous observers called a “mob.”

(It is perhaps no accident that Norris, in his recent Flyer interview, used the expression “it,” which he spelled out with the initials “I-T,” to describe Haslam’s Insure Tennessee proposal.)

The long and the short of it was that the concept of a state income tax became untouchable by members of either party, and the sales tax was forever enshrined as the basic source of state revenue. The aforesaid Senator Kelsey attended to the “I.T.’s” formal burial recently by spearheading the constitutional amendment prohibiting it that was passed by a statewide vote in November.

And, as a consequence of his tax proposal, Sundquist became anathema in state GOP circles, though he had been backed by such traditional Republicans as Memphis’ Lewis Donelson and by a variety of business-minded groups.

Jackson Baker

for a unanimous endorsement of Insure Tennessee.

Significantly, Haslam, too, has support from such sources. The state Chamber of Commerce has backed his Insure Tennessee proposals, and Phil Trenary of the Greater Memphis Chamber is an especially strong advocate. Equally telling was a 12-0 vote of endorsement of the governor’s plan by the Shelby County Commission two weeks ago. The sponsor of that vote was Terry Roland of Millington, one of the most vocal and consistently conservative of the commission’s six Republican members.

For Roland and the other supporters of Insure Tennessee on the commission and elsewhere locally, the matter is a no-brainer: Memphis’ Regional One Health facility, which is responsible for the lion’s share of indigent medical care in Shelby County and in adjoining West Tennessee, Arkansas, and Mississippi, is in sore need of the funds Insure Tennessee would provide.

Spokespersons for other major health-care facilities as well, including the Baptist and Methodist hospital systems, have lobbied persistently for Haslam’s plan.

Even so, passage of the measure will be touch-and-go. Speaking before a local Republican women’s group earlier this month, several local Republican legislators appeared to vie with each other in citing reasons not to pursue Insure Tennessee. State Representative Curry Todd forecast that the coming special session would become a “bloodbath,” and relatively moderate House member Steve McManus expressed a fear that Medicaid expansion under Insure Tennessee would become a costly “Hotel California” that the state could enter into but never leave.

Ironically, the governor’s plan has what Haslam has advertised as a fail-safe against such a prospect. As proposed, Insure Tennessee, which would provide health-care coverage for at least 200,000 currently uncovered Tennesseans, would involve no increase in state funding whatsoever. The funding for the first two years — again, estimated to be between $1 and $2 billion — would be borne by the federal government.

Should there be a default, intentional or otherwise, by either the federal government or the Tennessee Hospital Association, which are pledged to assume 90 percent and 10 percent of the subsequent funding burden, respectively, Insure Tennessee would sunset automatically, the governor insists.

That fact, a funding formula free of new state obligations, allows for one of the two most important distinctions between his current predicament and that which faced Sundquist, whose tax-reform plan called for raising additional state revenue, even if offset by federal income-tax reductions for individual taxpayers.    

The other distinction between Haslam’s situation and Sundquist’s is that the latter was dealing with substantial Democratic majorities in both legislative chambers, a fact tilting both bodies toward at least the concept of governmental intervention as a remedy for social problems. Haslam confronts a Republican super-majority in both chambers, including Tea Party members and other arch-conservatives opposed to the very idea of governmental expansion, regardless of the paying formula.

The fact of that anti-government bias will be the chief obstacle for Haslam to overcome in the special session, which Norris and other Republicans want to hold to a single week. 

But it will also be a factor in the regular session to come, when there will be mounting opposition to the administration’s support for Common Core educational standards (decried as creeping federalism by Tea Party members and opposed also by state teacher’s organizations for other reasons) and its defense of the endangered Hall Income Tax on annuities (which Haslam regards as important to maintain, given the state’s existing revenue needs).

There will be legislative pressure, too, to move further on imposing new restrictions on abortion than Haslam might prefer, though the governor gave at least formal assent to the passage of Constitutional Amendment 1 on last November’s ballot, which gives license to renewed anti-abortion measures.

Does this last feature seem to contradict the stated bias of so many members of the GOP super-majority against stepped-up governmental activity? Maybe so, but it won’t affect the realities of what happens in Nashville in 2015, any more than logical inconsistencies on approaches to Insure Tennessee will.

Categories
Editorial Opinion

Support Insure Tennessee

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.