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Will Tennessee join Virginia in Medicaid expansion?

Jennie Young • Jun 6, 2018 at 7:30 AM

The headline on a May 9 article in the Johnson City Press read “Poll shows Medicaid expansion has support.” My first response: “Well, so what? And here we go again.”

An April poll by Mason Dixon Polling and Research shows 63 percent of Tennessee voters favor Medicaid expansion. This provision of the Affordable Care Act means insurance for those who earn too much for TennCare but not enough for coverage through ACA exchanges, completely federal-funded for the first three years, and 90 percent thereafter.

Tennessee and 18 other states have so far refused this benefit to the working poor, but four of those states, including neighboring Virginia, seem to be coming to their senses. Locally, Ballad Health’s CEO Alan Levine recently voiced his support. The House minority leader, Democrat Craig Fitzhugh, recently led an attempt to allow the governor to effect this change, as governors in most of the Medicaid-expansion states had the authority to do, but it failed in our House of Representatives.

Polling in favor was even higher at 67 percent two years ago when Gov. Bill Haslam introduced his Tennessee-specific version, Insure Tennessee. The Tennessee Hospital Association lobbied strongly for this, as did local hospitals. The Tennessee Chamber of Commerce and the wider business community recognized the economic advantages and voiced clear support. With two-thirds of the populace and with the power of Tennessee’s businesses, in many cases with people in leadership positions and well versed in the program, success should have been guaranteed. It would let almost 300,000 low-income working people have medical coverage, which ought to speak to that place in us where compassion resides. But, no.

Back in the summer of 2016, the local Democrat Resource Center and other healthcare advocates joined with Tennessee Health Care Campaign and the Tennessee Justice Center in holding town hall meetings for informing grassroots support, inspiring direct interaction with our state legislators and civic action at the capitol. Local support was encouraging. We didn’t want to plan too small, and that‘s good because 250 showed up in Johnson City and closer to 300 in Jonesborough.

In spite of local support, only two of our lawmakers declared themselves on board, Rusty Crowe (changing his view, and his vote) and John Holsclaw of Elizabethton, who’d been there all along. Matthew and Timothy Hill and Micah Van Huss were clearly opposed, even to Haslam’s version which stressed personal responsibility. New to the job, Rep. Bud Hulsey of Kingsport attended a town hall and listened but didn’t commit.

Clearly even overwhelming public opinion, business pressure, facts, economic good sense, hospital health, not even moral imperative has dented the hard-wired ideological opposition to Medicaid expansion. Nor has the stark fact that Tennessee leads this country in rural hospital closings since 2010. Nor has the success and economic advantage reported by expansion states. All of which shows me denial and suppression of the people’s voices in Tennessee. I’ve heard only two common rationales for such outright arrogance. We must come to understand why we are being ignored and held back by a small group of legislators, so I’ll give it a try.

First they said wait for a Republican president (which at the time seemed unlikely for at least a decade) because then they’d be better positioned to get Medicaid money in the form of block grants. They claim block grants enable states to handle money more responsibly than the federal government. In reality, it’s a sly and politically useful way to weaken programs they oppose. Track records of block grants show that states often end up doing the minimum required to get federal dollars, then maybe find other ways to use up the money. It has not materialized even under Trump and a Republican congressional majority, and yet here we are, years later with hundreds of thousands of working people, tens of thousands in East Tennessee, denied access to routine care. And our hospitals are still footing the bill for uncompensated care, including many dire emergencies, with this situation clearly solvable as a matter of political will.

The other reason often given is maudlin to the point of embarrassment. Because it was just so emotionally burdensome for tender-hearted legislators when thousands of Cover Tennessee participants were dropped from the program, back a decade and a half or so, they can’t bear ever facing that again, in case the federal government might default on its commitment. Do they bother asking eligible people if right wing ideological purity is worth going without healthcare? Those only a few years away from Medicare eligibility? Aren‘t we talking about early discovery of potentially serious illness?

On their own account, their political views apparently don’t inhibit many of our legislators in the routine acceptance of Cadillac health coverage, taxpayer supported of course.

I’ve listened very carefully, and generally gleaned little more from all this stonewalling than the two rationales given above. And darned if they aren’t framed in nearly identical language. Why, a person could even suspect it was fed to them in an organized way. Maybe the fact that they sure aren’t listening to us means they may have found other enticements more appealing than the simpler rewards of public service.

Jennie Young of Elizabethton is a retired language arts teacher.

EDITOR’S NOTE: The opinions expressed by all Community Voices columnists are their own and do not necessarily reflect the official positions of the Johnson City Press.

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