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Community Voices: Tennessee GOP has abandoned the poor and rural hospitals

August 18th, 2014 11:21 am by Judy Garland

Community Voices: Tennessee GOP has abandoned the poor and rural hospitals

My good friend just had a second hip replacement with a two-and-a-half-day post-surgery recovery in the 6500 Joint Replacement Wing at Johnson City Medical Center. She was in awe of the impeccable skill, professionalism and compassion exhibited by every member of the staff during her first time round several years ago.

Her second experience has only deepened her admiration for this remarkable team, which routinely goes about its life-enhancing work.

In recent years, we’ve both been involved in efforts to provide affordable health care through the Affordable Care Act. In fact, it’s how we met. We applaud the gains.

We’re dismayed, however, that members of the majority party of the state General Assembly — Republicans led by Lt. Gov. Ron Ramsey — have summarily blocked access to insurance for Tennessee’s working poor (up to 138 percent of poverty) by refusing the Medicaid expansion provision of the ACA. They’ve not only abandoned hundreds of thousands of our neighbors to limited emergency room care, but they also expose our hospitals to financial jeopardy.

Conversation in my friend’s hospital room naturally flowed there. How very deeply wrong is any decision that threatens the functioning of such an exemplary unit in our local hospital, particularly when motivation is ugly and partisan. This mustn’t stand.

Too few of us understand how this came about or even realize the threat to our hospitals, particularly the rural ones. Here’s a time line for making some sense of it.

When the Obama administration, members of Congress willing to put partisanship aside, insurance executives and the medical community created the provisions of the Affordable Care Act, the nation’s hospital associations reached an accommodation with the other players. Prior to the launch of the ACA, the federal government had reimbursed hospitals for uncompensated care of the indigent and uninsured. The agreement was that federal reimbursement would end on Jan. 1, when everyone could be insured, either through affordable access or through expanded Medicaid.

Government money would be rerouted to the states to provide insurance for the working poor, who make too much to qualify for Medicaid but too little to afford insurance. For three years, expanded Medicaid would be covered 100 percent by the federal government, essentially returning to each state income taxes paid by citizens of that state.

After three years, states would receive 90 percent reimbursement. They would be free to opt out if 10 percent responsibility proved burdensome, which is unlikely, as hospitals were set to dramatically improve their bottom lines, which in turn improves local and state economies.

But then the U.S. Supreme Court intervened. It declared the ACA constitutional with one caveat — state legislatures could opt out of accepting Medicaid expansion. If the justices responsible could have foreseen the resulting threat to our hospitals, perhaps they would have thought better of opening that can of worms in a polarized political atmosphere.

You see, they gave partisan state legislators the option of denying hospitals the only means they would have for recouping the cost of treating the uninsured poor (whose basic care hospitals are not allowed to deny). Think about this — the court didn’t give hospitals the option of declining the cuts set to begin on Jan. 1. Then they put the only means hospitals have of recouping losses into the hands of partisan legislators, who too often choose the childish drama of thumbing their noses at the president over the financial health of local hospitals.

So, here we are. Hundreds of thousands of Tennessee’s working poor are denied access to care while millions of their counterparts in a majority of states have personal physicians and top-notch hospital services — just like everyone else. Doctors and hospitals are compensated. The money Tennessee taxpayers have paid don’t come back to us through this sensible solution. Instead, our money goes to other states who put their citizens first.

It’s unknown how many actually die from lack of access, but it happens. How uncommon, dumb and cruel is that? To deny basic health care for hundreds of thousands of our working poor for three full years — for free — because we’re fearful of what our economic situation might be at the end of those three years is absurd reasoning, particularly when it threatens the financial stability of a basic and necessary service. It seems to me this thinking shows a lack of confidence by Republicans in their ability to manage the state’s finances and the efficacy of their ideology.

It’s not unusual for small-minded individuals to inhabit statehouses. The Supreme Court is the bigger worry. It made a mistake in trusting statehouses to make good choices regarding Medicaid. The American Medical Association, the American Nurses Association, the American Academy of Family Physicians and the American College of Obstetrics and Gynecology charge that the justices just issued another harmful shortsighted ruling. The Hobby Lobby decision, they say, displays an insidious creeping into their area of expertise by five absurdly-biased and medically-unqualified male justices.

The sad irony is even the smallest-minded legislator and the most biased judge receives Cadillac health insurance at taxpayer expense.

Judy Garland of Johnson City is a health care activist.

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