In A State Desperate For Expanded Healthcare Access, TN GOP Sets The Stage For Potential Cuts To 1.4 Million

Author David Weatherspoon

About 1.4 million Tennesseans get their health coverage through Tennessee’s Medicaid offering in TennCare. That number is about 300,000 less than it would have been if Tennessee legislators had taken Medicaid expansion funds in 2014 when the Affordable Care Act offered Tennessee roughly $1.4 billion annually to expand coverage. Failing to do so has cost many Tennesseans access to health care through lack of insurance. [1]

It’s also meant billions of dollars legislators said “No thanks” to that could have directly benefited many in our state. The lack of those resources has contributed to the closures of ten rural hospitals throughout the state. Other hospitals have eliminated all inpatient services and are now a shell of their former selves. [2] The Tennessee Hospital Association estimates that each rural hospital accounts for 20 percent of each community’s economy.

Another legislative session just ended. Once again, Tennessee’s legislative body failed to accept these Medicaid expansion funds thus keeping nearly 300,000 people without coverage. Please understand that these are federal tax dollars that we as Tennesseans are already paying out of pocket in federal taxes, but don’t get the benefit of when it is time to help people in Tennessee.

Instead, just as the session was about to end, the Tennessee House and Senate agreed in the eleventh hour to seek permission from the federal government to “block grant” the $7.6 billion the state receives annually for its 1.4 million TennCare recipients. We would be the only state in the country to receive funds this way and it has raised alarms about the possibility that this is a precursor to benefit cuts. 

The application for waiver contained virtually no details about how the “block grant” would administer these funds.  When confronted with this, the GOP-led legislature indicated that it wished to give the Governor “flexibility” in determining how best to utilize these dollars. Conveniently missing from this “flexibility” are the details of how such flexibility would be used. How are we to trust legislators with more control over the benefits of 1.4 million TennCare recipients when they have thus far used their “flexibility” to deny health insurance coverage to 300,000 Tennesseans?

Many on both sides of the aisle are rightly worried that block granting will inevitably lead to cuts in services currently being provided by TennCare. Currently, there is no cap on federal money allotted to the state as benefits are determined by the number of beneficiaries and their individual medical needs.  The difference between the current program and the “block grant” becomes most evident during periods of economic downturns when the number of people receiving TennCare benefits always increases.  By setting a fixed block grant rate in a period of economic upturn, Tennessee would leave itself exposed when the economy inevitably experiences a downturn.  Other states will have their Medicaid funding increase with increased need, while we will have our funding frozen.  In that environment, the only choice we will have left the state is to exact deep cuts in services.

The State Legislature is on the wrong path, but there is a clear way forward.  The legislature would be better served by people who pay attention to the needs of voters within our state. This should start with making sure Tennesseans have access to affordable and quality health care. Therefore, we should accept the billions of dollars in Medicaid funds and expand health care coverage.  We also need to end this untested, think-tank “block grant” experiment before it impacts the lives of our state’s elderly, children and disabled.

However, we should not stop there. According to the Robert Wood Johnson Foundation, health outcomes are affected by a series of factors including social and economic opportunities.  These include supportive communities, good schools, stable jobs, and safe neighborhoods.[3] These should be the focus areas for our representatives as they make determinations about how to allocate our tax dollars. We have significant health needs in our state, and we need representatives who have the wisdom and the compassion to appropriately address these needs. We need people with a good moral compass that serves to guide them as they make decisions that affect the livelihoods of Tennesseans. It is time to demand that our legislators bring home our tax dollars and use them to fully fund Medicaid so all Tennesseans can have their health needs met. It is time to insist that they focus on the issues that matter.  The time for “flexibility” has passed.

[1] https://www.tennessean.com/story/news/health/2019/05/07/bill-lee-poised-sign-medicare-block-grant-tenncare-bill-overhaul-health-care-low-income-tennesseeans/1128410001/ 

[2] https://www.tennessean.com/story/money/industries/health-care/2019/02/14/rural-hospital-closures-ducktown-tn-gov-bill-lee-copper-basin-medical-center/2118872002/

[3] http://www.countyhealthrankings.org/

Written by David Weatherspoon