Medicaid expansion is a program under the Affordable Care Act which provides federal funds to states which agree to pay 10 percent of the costs for the increased healthcare access. Our version of Medicaid in Tennessee is known as TN Care. Tennessee is one of 14 states that has refused Medicaid expansion.
Tennessee legislative leaders express concern that Medicaid expansion would not be fiscally responsible for the state budget.
While I point out a view on Medicaid expansion different from the position taken by the state’s legislature, it is appropriate to compliment Tennessee leaders for their overall fiscal responsibility. Tennessee’s bond rating is at the highest possible level by all three major credit rating services. Only 13 other states enjoy this level of confidence in the financial markets. A high bond rating means Tennessee gets the best interest rates when it sells bonds to finance projects, so more taxpayer dollars go toward the actual projects and less go to paying interest.
Tennessee legislators are not just talking the talk on fiscal responsibility, they are also walking the walk. I wish the Federal government would follow this example.
I do feel a strong case exists that accepting Medicaid expansion is the fiscally responsible thing to do. Yes, as a physician, I want Medicaid expansion so more patients can get the care they need, so more money is available to fight the opioid epidemic, so hospitals are less likely to close and leave patients in the lurch. But I’m going to make the case that improving healthcare access for citizens is also fiscally responsible for our state.
Keep in mind that 90 percent of the expansion is paid for by Federal dollars. Also remember that former governor Bill Haslam supported Medicaid expansion, but the legislature rejected it. Of course, Tennesseans don’t get to pay reduced federal income taxes just because our state legislature rejected Medicaid expansion. Instead, our Tennessee federal income tax dollars flow to Virginia, Kentucky, New York and all the other states that have accepted Medicaid expansion. Tennessee taxpayers send $1.4 billion a year ($3.8 million every day) to other states to pay for the improved healthcare of their citizens.
It turns out that Medicaid expansion is believed to pay for itself by increasing economic activity and thereby increasing state revenue. Evidence shows that citizens of states with expanded Medicaid experience improvements in both physical and financial health. States that expanded Medicaid actually spend less on social and health services, and see more job growth.
The large number of uninsured patients in our state puts a huge strain on hospitals, especially rural hospitals.
Tennessee leads the nation in the rate of rural hospital closures. When a rural community loses its hospital, the results are catastrophic. Not only does the health care for the citizens suffer, but the local economy suffers as well. Hundreds of citizens lose good-paying hospital jobs. Outside businesses looking to relocate will not even consider towns without hospitals since they want healthy employees, so local economic growth is stagnated.
A second reason cited by Tennessee legislators for rejecting Medicaid expansion is framed as a humanitarian concern. They do not want to provide a benefit if there is a risk that in the future it might be taken away after citizens have come to rely upon it. This actually happened during Gov. Bredesen’s tenure in 2003-04, when the State government disenrolled over a quarter-million Tennesseans from TennCare. This experience was agonizing for citizens who lost coverage and it was politically difficult for many of Tennessee’s elected officials. It is understandable that many officials do not want to risk going through such a process again.
The Federal government is fairly unpredictable at present and the concern that Federal participation could be cut to less than 90 percent at some point in the future seems valid to me. Perhaps there is a way for state legislators to expand Medicaid but ensure that, should federal financial support drop, any Tennessee response would be the fault of the federal government, not the state government. For example, a clause incorporated into the law expanding Medicaid could state that, if the Federal contribution dropped below a certain level, then the expansion would end.
Medical expenses are the No. 1 cause of personal bankruptcy in the United States. I’ve heard stories from East Tennesseans that are heart-wrenching. Parents who have to decide whether to spend money on new school shoes or their own insulin. Couples married for decades who have to divorce in order to keep their home (the healthy one gets the house, the sick one declares bankruptcy). As a physician, it is these stories that drive my interest in promoting Medicaid expansion. But the economic benefits are solid as well.
Doing the right thing for healthcare requires both wisdom and political courage. Ben Franklin famously warned against false thrift, the mistake of being penny-wise and pound-foolish. It is wise to question the reasons that Tennessee rejected Medicaid expansion. I hope our Tennessee leaders will recognize the economic benefits of Medicaid expansion to our state and will stop the transfer of funds from our taxpayers to patients in other states. In the case of Medicaid expansion, improving the citizens’ healthcare also makes responsible economic sense.
Dr. Marty Olsen is an obstetrics and gynecology physician in Johnson City. He has interests in international medicine and in confronting the opioid epidemic.