It’s four years now since Tennessee’s state legislators blocked federal funding for health insurance for thousands of low-income Tennesseans and stopped federal reimbursement to hospitals for uncompensated care for the uninsured. They’re back in session now, and it’s way past time to change this self-defeating pattern. The roadblocks have a lot to do with who our majority legislative leadership listens to, and it’s definitely not our traditional in-state voices.
Tennessee is targeted by conservative out-of-state big money organizations, the most powerful of which is AFP (Americans for Prosperity), sponsored and heavily funded by the billionaire Koch brothers. They‘re here to influence our politics for many reasons, but especially because we border nine also conservative-leaning states. With both governor and Senate races on the ticket in 2018, this will be a bumper year for intrusion of outside money, and our governor has urged state newspapers to be vigilant, to keep us informed.
In 2015, we experienced first-hand the direct power of big money to influence and embolden a small number of strategically positioned state senators. They denied a floor vote on Governor Haslam’s carefully crafted Insure Tennessee program to expand Medicaid to approximately 300,000 eligible low-income Tennesseans, which had seemed likely to pass both houses. That number, by the way, includes 20,740 of our local citizens in Washington, Carter and Sullivan counties. It was no coincidence that 2015 was the year the AFP swarmed into the state to pressure legislators and pack our public-seating galleries in their rowdy red shirts. And they stayed, with headquarters now located across the state.
Haslam’s plan was created to address legislators’ concerns (real or politically concocted) about Medicaid expansion, made available to states under the Affordable Care Act in 2014. Those “concerns“ caused the legislature to immediately ban use of the federal funds specifically allocated, and still available, to Tennessee. Those funds would have returned tax money to our state to pay 100 percent of cost of expansion for 10 years, and 90 percent thereafter. It took a lot of outside $influence$ to turn that down.
Their choice meant thumbing their noses at 67 percent of the public, many of their Republican colleagues, and the urging of the state Chamber of Commerce, the Tennessee Hospital Association and physicians and nurses associations.
The high public support, general bipartisan legislative support, and the support of the medical and wider business communities was rooted essentially in pure economics. Although thousands of us regarded it as a moral imperative and said so, even we were shaking our heads over the indefensible disregard for the public economic interest. It’s been costly. The legislature itself estimates we have since lost $5 billion and we lose $3.8 million every day. University of Tennessee economists estimate we’ve given up at least 15,000 good-paying jobs. And we all bear the cost, and shame, of leaving hundreds of thousands of low-paid working people uninsured, for no defensible reason.
Since 2014, based on our size, Tennessee has suffered more rural hospital closings (seven so far, I think) than any other state, with others cutting back services. Our hospitals are six times more likely to close because the legislature continues to block desperately needed funds. By data reported in the Annual Report on Tennessee Hospitals, some of Northeast Tennessee’s hospitals are on shaky ground, including Johnson County Community Hospital and Unicoi County Memorial Hospital. With the opioid crisis in Northeast Tennessee afflicting so many families, it is likely to grow worse because legislators adamantly refuse to free up our own federal health funds for addiction prevention and treatment.
I still seethe when I recall the roll-call vote to put the final nail in the coffin of Insure Tennessee by the Commerce and Labor Committee in 2015. One crisp “no” from each senator, right down the line, except the two Democrats, without discussion. They had condescended to move Insure Tennessee to first on the agenda and allowed proponents to speak. TennCare representatives described how their program would benefit. A Maury County Hospital official reported the hard choice to shut down their open-heart surgery unit for lack of funds. Republican Sens. Richard Briggs and Doug Overbey, co-sponsors of Insure Tennessee, spoke eloquently of healthcare advantages and the impressive economic gains to the state, Overbey calling it a “home-run.” Then came, “Thank you, gentlemen. Will someone call for the vote?” They had come to kill it, which they brazenly did.
Only public pressure can put another healthcare decision on their docket. It’s beginning, so please watch and listen for opportunities to join in. I recently heard someone I admire say that well organized people can beat organized money every time. Well, I sure hope so. That does seem to be playing out across the country. Virginia experienced it dramatically in their recent election, and NPR just reported that its House of Delegates passed Medicaid expansion and support is building in the Senate. Will Tennessee be left trailing behind?
Judy Garland of Johnson City is a community health care activist.