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State Republicans will have to cave on Medicaid

Judy Garland • Dec 16, 2013 at 9:21 AM

Many Tennessee hospitals have already made painful choices, limiting their capacity to serve with their usual high degree of performance and availability. There’ll be closings of rural hospitals, closings or limiting of oncology units, and steep reductions in necessary trained staff. Our state’s medical leadership doesn’t sugarcoat the causes, and I understand they’ll be even more vocal soon. To be supportive, our job is to be informed and involved.The austerity measures are tied primarily to the refusal to expand Medicaid and, to a lesser degree, to Republican-forced sequestration and other budget cuts. Conservatives will say Obamacare is the cause, but that’s without base. Hospital associations agreed during the crafting of the new law to receive less federal help for uncompensated care and other reduced federal payments. To offset those reductions, they designed the new law to expand health coverage through Medicaid. By the Tennessee Hospital Association’s calculations, Tennessee would receive $32 for every $1 invested in TennCare expenses in the first five years, amounting to billions of dollars for local and state economies. These billions, ironically, are billions we pay in taxes that would come back to us through expanded Medicaid — but will go to other states if we don’t.Simple and straightforward. An obvious choice, right? Without politics, yes, but, oh my. The conservative members of the U.S. Supreme Court foolishly changed one provision of the Affordable Care Act, giving the states the choice to expand Medicaid, and look what they’ve wrought. Most of the red states immediately embraced one more way to attack the president. Please, give this a thought: Might this compulsion to hurt the president do its destructive work elsewhere and hurt us instead? It’s already happening in Tennessee, which is why conservatives will fail in spite of bluster from Nashville. One by one, red states are caving and expanding Medicaid, pressured by their grass roots to swap a hurtful ideology for human decency.What’s happening in big powerful red Texas is set to shake the most arrogant, entrenched conservative ideologue. Molly Davis, a reporter for The Dallas Times Ledger, wrote on Dec. 3 that Texas’s Republican state legislators, themselves forced by constituents, have forced Gov. Rick Perry to the bargaining table to give him no option but to expand Medicaid. The state with the highest percentage of uninsured has awakened and their Republican-dominated state house knows better than to ignore them. Gov. Perry was still adamant about never giving in, but his Republican lawmakers understand why he must be overruled.One interviewed for the article “shook his head with an air of resignation. ‘Yeah, I got caught up in the tea party and the Perry presidential run and then the Cruz crusade, but, ya know, I got people to help, who have kids to feed and grandparents to take care of, and I’m not going to let them down.’” Exactly. He continued: “I went to the local tea party meeting last week and ya know how many people were there? There were six people there. Two years ago ya couldn’t fit them in the building there were so many of them. “Yesterday I talked to the spokesman and he just signed up for Obamacare. I asked him ‘what are ya doing, John?’ and he just shrugged his shoulders and said, ‘I’m doing what I got to do, you got your insurance, just what do you expect me to do?’ And he just walked away from me.” Exactly.Texas legislators’ change of heart gets a powerful push because outside their office windows they see the Turn Texas Blue “outfit that means business,” signing up people for health care and registering them to vote. “The sense of panic in the Republican caucus,” one says, “is so thick you could cut it with a knife.” Conservatives will rue their boast that no Republican voted for the Affordable Care Act.The people of Kentucky are having such a positive experience getting health care that U.S. Senate Republican Leader Mitch McConnell is in trouble for opposing that good thing. Virginia’s new Democratic governor comes to a state house appearing more ready to make the decent choice for their people. We’re just over the border. It won’t take long to register that we’ve been snookered. Tennessee Gov. Bill Haslam’s obstinacy isn’t characteristic, and I think he’ll do the right thing. Lt. Gov. Ron Ramsey typically struts and threatens to defy the governor should that happen, but he’ll lose in the end, sputtering as coherently as he‘s capable. I know little about state House Speaker Beth Harwell, but I don’t sense she’s narcissistic enough to defend a discredited position, a la Ramsey’s regrettable style.If our hospitals would hang huge outdoor banners exposing these three in advance of significant cuts or closings threatening the facility, we’d see a scrambling for a more responsible outcome. Your voice is power, and here’s all you need. Contact Haslam at bill.haslam@tn.gov or 615-741-2001; Ramsey at lt.gov.ron.ramsey@capitol.tn.gov or 615- 741-4524; Harwell at rep.beth.harwell@capitol.tn.gov or 615- 741-0709; state Sen. Rusty Crowe at sen.rusty.crowe@capitol.tn.gov or 615-741-2468; and state Sen. Steve Southerland at sen.steve.southerland@capitol.tn.gov or 615-741-3851.Judy Garland of Johnson City is a community activist.

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