A Guest column by League member Carolyn Krause
Reprinted from the January 21, 2022 edition of The Oak Ridger, USA Today Network, page 3.
When I pay income taxes to the federal government, I like to think that some of that money will come back to our state to benefit my fellow Tennesseans and me. I also like to think that the purposes of our state government include protecting the health and safety of state residents and helping us prosper. I keep forgetting that the number one priority of many of our elected representatives is to stay in power. Providing us the services they promised is lower priority.
A case in point is the refusal of the state of Tennessee since 2014 to accept over $10 billion in federal health care benefits for the working poor – some 300,000 low-income, uninsured Tennesseans who may be the most disadvantaged people of this state. This rejection of federal funds by Tennessee (and 11 other states) has done considerable damage.
I learned about this conundrum by listening to and writing about two virtual forums on the need to expand Medicaid in Tennessee. It was sponsored by the League of Women Voters of Oak Ridge, the League of Women Voters of Tennessee and the Tennessee Health Care Campaign. The second virtual forum featured two Knox County legislators in the Tennessee General Assembly – Rep. Gloria Johnson (D), whose uninsured sister and brother-in-law lost their jobs and home when her sister became ill, and Sen. Richard Briggs (R), a surgeon who has sponsored an unpassed bill in support of Medicaid expansion since 2015.
Many of the 300,000 uninsured include essential workers who have served us food in restaurants, built or remodeled our homes and cared for children and elderly who are homebound. Some have lost or left their jobs because of the COVID-19 pandemic. These unfortunate folks can’t afford private health insurance offered on the Affordable Care Act exchange and they can’t get TennCare’s Medicaid insurance mainly because they are not pregnant, elderly or disabled, have no dependent children or make too high a wage.
Because they are stuck in the health insurance coverage gap, they often delay care for an injury or infection. Why? Because they fear receiving an unaffordable medical bill. Some die early, preventable deaths as a result. Others go to the emergency room late for needed care, receive an unreasonably high medical bill and declare bankruptcy. As a result of unpaid exorbitant medical bills, Tennessee has one of the nation’s highest numbers of personal bankruptcies.
The state’s rejection of Medicaid expansion has damaged rural communities. In at least 14 of these, their hospitals have closed because few residents are insured and have the ability to pay medical bills. As a result, highly paid doctors and other healthcare employees have left, reducing support for town businesses, churches and charities. State officials know it is futile to try to attract new businesses and industries to rural communities with no hospital services. State politicians should not be proud that, after Texas, Tennessee holds the record for having the highest rate and number of hospital closures in the nation.
Under the American Rescue Plan Act of 2021, states that adopt Medicaid expansion have to pay only 5%, not 10%, of the cost, with the rest being federally funded. When this law was passed, Tennessee hospitals jointly pledged as a group to pay the state’s contribution to Medicaid expansion. A recent poll indicated that 65% of Republican lawmakers in the Republican-led Tennessee General Assembly support Medicaid expansion whereas only 15% oppose it while 20% have no opinion.
Many of the supportive lawmakers probably know that Tennessee exceeds the national chronic diseases: diabetes, high blood pressure and cardiovascular disease. Most know that a growing number of Tennesseans suffer from mental illness and drug abuse. At least a few are aware of the published Harvard-Vanderbilt study titled “Medicaid expansion slowed the rate of health decline for low-income adults in Southern states.” Are some legislators holding back on supporting Medicaid expansion because of campaign funds they receive from Americans for Prosperity, the Beacon Center of Tennessee and the National Federation of Independent Business (all of which oppose expansion)? Are some rejecting the deal because they were fundamentally opposed to the former president whose administration enabled Medicaid expansion? Do they really see the additional funding as an entitlement for unfortunate folks they view, or stigmatize, as lazy and unwilling to work? Are they truly afraid that the federal government might pull out of the deal and leave the states responsible for funding most of the Medicaid insurance for a larger population?
Gov. Bill Lee has not supported Medicaid expansion probably because he believes such support might keep him from being re-elected. Rep. Johnson stated that “keeping Tennesseans healthy is good economic business” and Sen. Briggs said, if the governor is re-elected, he is more likely as a businessman and strong leader to champion Medicaid expansion and “explain to the public its economic advantages.”
I hope the senator is correct but I wish our politicians would act now. Tennessee is a liberty-loving state but we must remember that the Declaration of Independence mentioned two other rights that should not be taken away: life and the pursuit of happiness. Enjoying these unalienable rights is difficult when thousands of Tennesseans are seriously ill and dying because they lack health insurance. Everyone has a right to good healthcare. That’s why I want some of my money and yours to be returned to the state to help improve the health of all Tennesseans.
Carolyn Krause, LWVOR