Sen. London Lamar. Photo Credit: Tennessee Senate Democratic Caucus
Sen. London Lamar (D-Memphis) has introduced a bill to ensure that children in Tennessee not only get equitable healthcare, but they’re able to keep it.
Lamar’s bill would implement continuous eligibility for children who are enrolled in TennCare and CoverKids. Senate Bill 1828, introduced by Lamar and Memphis Democrat Rep. Antonio Parkinson, would ensure that children who have healthcare coverage under these programs are continuously having their coverage renewed.
If passed, Lamar said this bill would solve the problem of children losing state healthcare coverage due to “procedural reasons — not eligibility.”
“[SB 1828] prohibits the bureau from subjecting the minor to a redetermination of eligibility or disenrollment except under certain circumstances,” reads the bill.
Lamar said accountability measures are included to ensure fraud isn’t being committed, and parents are not applying for any children who are deceased.
Lamar said she wanted to focus on topics that impact families the most. She said the most vulnerable populations in the state tend to be children, and she wanted to push for all children to have access to healthcare.
“I know one population we can make a direct impact on is those children who are under state healthcare insurance programs,” said Lamar. “What we did find out was that many kids were taken off the health insurance plans because of clerical issues.”
The 2023 State of The Child in Tennessee report from the Tennessee Commission on Children and Youth showed that 29,154 children in the state were disenrolled from Medicaid due to procedural reasons, while 6,838 were disenrolled from Children’s Health Insurance Program (CHIP) for the same reason.
“A significant component to ensuring children have access to health care is to protect those who are already insured or are eligible for insurance from losing coverage due to procedural mistakes on an application,” the commission said in a statement.
Lamar said she doesn’t think procedural issues are enough to take children off of healthcare plans. She said it’s common that people change addresses and move out of state, and wanted to make sure the state does its due diligence.
“Our families and our state are stronger when every child has access to health care,” said Lamar. “When children get the health care they need, they are more likely to succeed in school, graduate from high school and attend college, earn higher wages, and grow up into healthy adults.”
While Lamar is adamant about pushing for the legislation to be passed, she anticipates that TennCare won’t want to approve it, as she believes it will want to continue its current re-enrollment process
“I think it will definitely be an uphill battle with folks across the aisle,” Lamar said. “We’re going to push the issue as best as we can to get the support we need to get this bill across the finish line. But no doubt about it, it’s going to be tough.”
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.
Shelby County should be the spending focus for the state’s massive $571 million surplus of unused federal funds aimed to help low-income families, according to the organization that discovered the surplus.
Two weeks ago, the Beacon Center of Tennessee, the Nashville-based, free-market think tank issued a report called “Poverty to Prosperity: Reforming Tennessee’s Public Assistance Programs.” The report found that Tennessee spends only a fraction of the federal funds it gets to fund Temporary Aid to Needy Families (TANF) programs here.
One of those programs in Tennessee, called Families First, gives temporary financial assistance to eligible families with children in the form of a cash benefit, as well as employment and job search opportunities, according to the Beacon report. The TANF funding also helps fund TennCare, the state’s Medicaid program.
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Shelby County represents the largest caseload size of TANF (23.3 percent), TennCare (17 percent), and the Supplemental Nutrition Assistance Program (SNAP) at 22 percent, according to Beacon.
”Tennessee should invest in pilot projects focused on poverty in Shelby County and opportunities to provide more supportive wrap around services for working age adults that need childcare, transportation, education, and employment training services,” reads the report. “Successfully partnering with families in Shelby County to tip the scale in their favor to move from poverty to prosperity would have the single greatest economic impact for the state’s systems of support.” [pullquote-1]
In a letter Wednesday, Memphis Rep. Steve Cohen demanded answers from Tennessee Governor Bill Lee Wednesday on the state’s $571 million surplus of federal funds for needy families.
Cohen said Tennessee only spent $20 million of its $190 million federal allocation last year, leaving $170 million unspent on TANF programs last year. In all, the unused TANF funds totaled more than $732 million, according to Beacon. Cohen said his $571 million figure included only funds that weren’t yet obligated.
Initially, Lee adminstration officials defended the surplus, saying they’d need the extra funds for another economic downturn. After weeks of backlash over the surplus discovery, Lee said in budget hearings Monday that his office is working on a plan use more of the funding.
For starters, Lee said the Tennessee Department of Humans Services, which administers the TANF funds, will spend about an additional $70 million this year to nonprofit organizations.
But the assurance was apparently not enough for Cohen.
“When 15.3 percent of Tennesseans are living in poverty, it is inexcusable for the state to withhold millions of federal dollars allocated to help this exact population,” Cohen said in a statement. “At best, this has resulted in Tennessee’s gross mismanagement of federal dollars; at worst, Tennessee has deliberately chosen not to assist needy families.”
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Beacon’s report concluded that Tennessee should take the additional TANF funding and for the Families First program, “focus on creating innovative transition services that reward working parents for each move up the economic ladder toward stability and prosperity like transportation and childcare supplements for families who are working.”
As for TennCare, Beacon said Tennessee should use some additional TANF funding to ”take a deep dive into its caseload” and ”promote more access to care for its enrollees.”
For both programs and SNAP, Beacon suggested “Shelby County should be the main area of focus.” Beacon Center of Tenessee
Imagine the predicament on Tuesday of Wendy Long, director of Health Care Finance and Administration for the state of Tennessee, as well as, crucially, director of the state’s TennCare program, Tennessee’s version of Medicaid. Long, also a physician, was the scheduled luncheon speaker of the Rotary Club of Memphis at the Universitry Club, and, if she was late in taking her seat, it was, she would explain, because she was tuned into various news sources to get the latest news coming from Capitol Hill in Washington.
As it happened, Tuesday was also the day that Mitch McConnell (R-KY), majority leader of the U.S. Senate, had indicated he would require a vote in that august deliberative body relative to pending legislation regarding a possible repeal of the Affordable Care Act (aka Obamacare) and/or a possible replacement measure to govern the nation’s national health-care policy.
If that has a vague sound to it, it’s because McConnell’s intentions were indeed vague, as would be whatever mechanism he trotted forth for the unsuspecting Senators to deal with. McConnell’s legislative gambit on health care this week was even more a mystery than the one he laid before the Senate two weeks ago after clearing it in advance with only 12 fellow Republicans, members of an ad hoc committee appointed by the Majority Leader.
That bill, which polls showed only 11 percent of the nation’s population favoring, would have ultimately knocked some 22 percent of current insured Americans out of coverage. The bill got nowhere, as a fair number of Senate Republicans refused to go lock-step with it. (Democrats were universally opposed to both it and any other arbitrary measure repealing the A.C.A.)
On Tuesday, no one knew what McConnell had in mind at the time of Long’s scheduled Rotary appearance in Memphis. It was thought that he might seek a vote merely to forward in discussion of an as-yet-unknown health-care measure, or perhaps he had a specific bill in mind to seek a vote for, or …
Long had to wing it in her luncheon remarks, although she made it clear that any of several possible directions that the Senate (and later the whole Congress) might take on health care were crucial to Tennessee’s medical future — and especially to TennCare, a jointly funded federal/state program that administers to fully 50 percent of the state’s population, including, as she put it, “pregnant women, children, parents of children, the elderly, and the disabled.” Several of the pending Congressional possibilities under consideration by the GOP-dominated Congress — including a bill already passed by the House of Representatives and whatever has thus far been proposed in the Senate — would effectively either scuttle Medicaid at some point in the not-too-far-off future or impose unsustainable costs on Tennessee’s TennCare version.
Asked what outcome her department sought from Tennessee Republican Senators Lamar Alexander (one of McConnell’s erstwhile ad hoc group) and Bob Corker, Long answered: “Flexibilty,” (a word with numerous implications under the circumstances, some of them ironic). In her competent, detailed way, she had managed to suggest that otherwise the state — and its large population dependent on TennCare — would shortly be forced into a corner.
Given the fact that, even in Nashville, people were preoccupied on Monday with the forthcoming caucus results in Iowa, Governor Bill Haslam’s State of the State address garnered somewhat less traction than it normally
Tennessee Governor Bill Haslam
would. Not that his address wasn’t well received. The governor’s brag-bag of boasts and proposals was like a decently packed post-Christmas stocking, containing a fair number of comestibles, even if lacking in the surprise hardwares — an unexpected wristwatch, a brand-new iPhone —that can give the annual gift-giving ritual the sense of holiday-style delight.
Or, to paraphrase Gertrude Stein, there was not much there there. Conspicuously missing in the governor’s message was any mention of the two great issues that have been more addressed in statewide commentary and political cross talk than any others over the past year — Medicaid expansion and infrastructure repair. No Insure Tennessee pitch as with last year’s speech and no substitute proposal for accessing the billions of federal dollars still lying in wait for the state’s indigent population and struggling hospitals. No highway tax or any other concrete proposal (pun very much intended) for dealing with Tennessee’s deteriorating highways, roads, and bridges.
There was a small revenue surplus to feel good about and a modest boost in the state rainy-day fund, but these did very little to diminish a sense of continuing austerity. Nor, given the continuing blockage of Medicaid funds, did the governor’s statements concerning a “really well-run” TennCare system raise many pulses. And his satisfied proclamations concerning the state’s plans for its diminishing real estate may have gratified the outsource lobby, but they gave the rest of us something of an empty-nest feeling.
To be sure, there is some good news on the education front, including an investment, said Haslam, of “more than 414 million in new dollars in Tennessee schools, more than $200 million of that toward increases to teacher salaries.” The boast that went with that was less edifying. As the governor said, “we’re not investing in the same old public education system in Tennessee.” The raise in standards he claims to have achieved is disputed by many serious educators, and what he calls the “expanded education options for children” could also be described as the draining away of local responsibility for education as the state Achievement School District, unmonitored by any elected body, picks off schools, keeping them from thriving local initiatives such as the iZone program of Shelby County Schools.
State employees will come in for some pro forma (and long overdue) pay increases, although Haslam accompanied this bit of lagniappe with some cold-shower rhetoric regarding “the hard work and discipline of our departments” as mediated by “the conservative fiscal strategy employed by the General Assembly, our constitutional officers, and this administration.”
The governor used much of his address to lavish praise on the Tennessee Emergency Management Agency and the state’s first responders. He did not dwell much on Tennessee Promise or his various initiatives to boost adult education in Tennessee, but he is no doubt entitled to some commendation for these efforts.
All in all, his State of the State address recalled that old line about it being “the thought that counts.” Thought is fine, but we cannot escape the feeling that a little more action would have counted more.
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.
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.
Okay, so what happened to gridlock? In Washington, there was the passage of the so-called “Cromnibus” spending bill, which provides safe passage for $1 trillion in federal expenditures through 2015. No showdowns, no filibusters or cloture battles, no threats to shut down the government.
Granted, there are some objectionable provisions, and Senator Elizabeth Warren (D-Mass.) inveighed valiantly (but in vain) against one of them — a proviso that seemingly opens the door for big financial institutions covered by the Federal Deposit Insurance Corporation to resume the trading in derivatives swaps that contributed so much to the Big Crash of 2008-9.
But congressional Democrats didn’t want another shutdown battle and, for a change, neither did Republicans, who may, after their virtual sweep at the polls this year, simply want a chance to prove they can actually govern. There is still a gridlock of sorts. The word “cromnibus,” incidentally, is an amalgamation of “continuing resolution” and “omnibus.” The former term, often abbreviated as “CR,” denotes a decision to continue with the previous year’s spending and authorizations in lieu of an agreement. But only one aspect of this year’s omnibus bill had to be dealt with in that manner — funding for the Department of Homeland Security (DHS), which the GOP held up so as to leverage DHS funding next spring against President Obama’s executive actions on immigration.
Still, the end-of-year spending bill hearkens back to what, in comparison to gridlock, were the good old days of bipartisan wheeling and dealing, mutual backscratching, and backroom deals. That’s what constitutes “progress” in our time.
And in Nashville … After two years in which the state’s new Republican super-majority successfully blocked acceptance of millions of dollars in annual funding for Medicaid expansion under the Affordable Care Act (ACA), the GOP’s acquiescent but well-intentioned Governor Bill Haslam has somehow wriggled his twisted arm free and cut a deal with the feds! And even Ron Ramsey, the arch-conservative state Senate speaker and lieutenant governor who has more or less directed legislative policy during Haslam’s tenure, has professed himself open-minded about the plan that the governor is calling “Insure Tennessee.”
Never mind that Insure Tennessee may or may not be an ideal way of coping with the problem of uninsured Tennesseans or of applying the substantial federal subsidies that come with acceptance of this aspect of ACA. The plan’s complicated methodology has a Rube Goldberg-like look to it — one that will, we hope, get spelled out via debate during the special legislative session Haslam has called for in early January.
The point is that if the GOP’s legislative super-majority, which has granted itself veto power over any proposed version of Medicaid expansion, can be brought to accept Insure Tennessee, and, if the feds do follow through with a waiver for Haslam’s alternative, there are real benefits. Most importantly, TennCare, the state’s version of Medicaid, would get a badly needed infusion of operating funds, enough to help rescue Tennessee’s hospitals, so many of which are teetering on the edge of insolvency.
Make no mistake: Neither in Washington nor in Nashville is right-wing tunnel vision over with. In some ways it may be just beginning. But maybe there is light at the end of the tunnel — something worth groping toward, anyhow.
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