It was perhaps appropriate that Friday's annual Unicoi County Chamber of Commerce Legislative Breakfast was sponsored by Mountain States Health Alliance, as much of the discussion focused on the topic of Medicaid expansion.
MSHA President/CEO Dennis Vonderfecht was joined by State Sen. Rusty Crowe and State Rep. Kent Williams to discuss this issue and several others affecting the county. Field Representative John Abe Teague represented U.S. Congressman Phil Roe's office at the breakfast, and Field Representative Bridget Baird represented U.S. Sen. Bob Corker's office.
Vonderfecht said he expects the issue of Medicaid expansion will soon be addressed by the state's General Assembly, adding the issue is tied in with the Affordable Care Act. He said when the ACA, commonly referred to as "Obamacare," was being discussed at the federal level several years ago, the hospital industry decided to give up more than $150 billion in reimbursements over the next 10 years in exchange for health coverage to the approximately 32 million U.S. resident without health insurance at the time.
Vonderfecht said about half of the uninsured population will be covered by heath insurance exchanges, and Tennessee has opted to allow the federal government to run its exchanges.
When the Supreme Court upheld the ACA last year, it changed how the other half of the uninsured would be covered through expanded Medicaid programs, Vonderfecht said. He said the Supreme Court left the decision up to each state as to whether it would adopt the expanded program. Tennessee is one of the states that remains undecided on this decision.
Under Medicaid expansion, the federal government would cover 100 percent of the cost of the expanded TennCare population for the first three years. While this percent will eventually taper off before stabilizing at around 90 percent, which is still higher than the current Medicaid reimbursement, Vonderfecht said. He also feels the expansion will help offset standard Medicare cuts.
Vonderfecht said he and others in the hospital industry are in support of the expansion, as it means dollars taken from healthcare providers will be returned to the state. He said Medicaid reimbursements that Tennessee receives would be lost to other states that expand their Medicaid programs if expansion does not occur here.
"We have a lot of uninsured people that would qualify through an expanded program that we could get some coverage," Vonderfecht said. "It doesn't mean we're going to get all our costs covered, because we won't. TennCare pays us about 65 percent of what it costs us to take care of our patients, but that 65 percent is better than what we're getting today, which is nothing for that population that is not insured."
Crowe said the most critical aspect of the issue is that states have to decide on the expansion. He also said he expects Gov. Bill Haslam to make the decision on what direction Tennessee will go by the middle of April.
"The Governor's got a tough choice to make, a tough choice to make, and we as legislators have to think about it, as well, from a political perspective," Crowe said.
But Williams said politics should not play into the decision, and that he supports expansion as not getting on board could be detrimental to hospitals in rural communities.
If expansion does not occur, the state stands to lose around 90,000 jobs, with 9,000 of those within this region, Vonderfecht said.
Unicoi County Commissioner Bill Hensley asked the legislators about a bill that concerns 911 funding which could result in Unicoi County losing approximately $80,000 in state funding for its emergency dispatch service.
"I'm very familiar with that piece of legislation," Williams said. "Basically, it changes the (funding) formula. I think the formula now is based on calls, and it'd be based on population."
While metropolitan areas stand to benefit from this proposed bill, Williams said rural counties would experience lost funding. He said that although Carter County would see a funding increase due to the bill's passage, he said officials there are opposed to it due to the limitations it would put on local emergency communications districts while applying for grant funding.
Unicoi County Commission Chairman Mickey Hatcher voiced concern that the U.S. Forest Service's Watauga Ranger District office located in Unicoi County could be relocated out of the county. The Forest Service has leased the property where is located for years, and is looking at federally-owned locations for the office's relocation. Hatcher urged legislators to do what they could to keep the station in Unicoi County.
"I'm hoping we can keep that here in Unicoi County," Williams said. "It's always been here in Unicoi County and if we're going to build a facility, like you said, Unicoi County is basically federal lands over here and that's exactly where it should stay."
Williams also provided an update on the state park at Rocky Fork. He said county officials and legislators are working with the Tennessee Department of Transportation to get improve the arterial access road to the park's eventually location. He also said Tennessee Department of Environment and Conservation is also working on a master plan for the park.
Williams said he expects groundbreaking on the TDOT railroad overpass project to occur "when the weather breaks."
Note: An earlier version of this article incorrectly referred to Medicare rather than Medicaid. It has been corrected.