Moving the Needle for Medicaid Expansion in Tennessee Pt. 1

July 7, 2018 / Author: Hayes McAlister

Medicaid expansion in Tennessee

It has been 4 years and 3 legislative sessions since Tennessee’s General Assembly first had the opportunity to accept federal funds to cover 280,000 uninsured working Tennesseans through a provision of the Affordable Care Act. Since that time, the state of Tennessee has purposely refused to accept some 5.6 billion dollars despite the wide bipartisan support of Governor Haslam’s 2015 Tennessee-specific plan, Insure Tennessee. The Governor could not get the plan over the finish line, despite statewide support, thanks to former state Rep. Jeremy Durham (R-Franklin) and his intervention in the legislature in 2014. Durham’s law ties the hands of the governor and prevents Tennessee from bringing home our federal tax dollars without the express approval of the state legislature. The issue of Medicaid expansion and accepting federal dollars will only be resolved by the repeal of Durham’s law or an affirmative vote in the General Assembly.

The discussion surrounding low-income people and healthcare has long been overly political and expanding affordable care to more people is consistently overlooked to the detriment of hundreds of thousands of Tennesseans. Many residents do not know just how impactful expanding care would be to the state’s economy, rural communities and the healthcare sector. As we continue to make efforts to move the needle to expand Medicaid during the next legislative session, the most compelling argument is economic. Tennessee residents pay the same federal taxes as the people in 34 states (not including Washington, D.C., and Virginia, who recently passed Medicaid expansion in their legislature) that chose to expand Medicaid. These states see benefits from expansion across social and economic metrics that Tennessee does not. Tennessee loses 3.8 million dollars a day, or 1.4 billion dollars a year, by failing to accept federal funds to cover more working people. Tennessee taxpayers pay into the pot that provides funding for Kentucky and Arkansas to cover more of their residents and make their states healthier overall.

The injustice of foregoing the benefits that other states get moves Tennesseans into action. Growing support for Medicaid expansion relies on sharing information about the success of expansion in other states and the worsening outlook for Tennessee without expansion.

Tennessee health crisis

It does not take long to see and feel the reality of Tennessee’s dilapidated healthcare network. Many Tennesseans in urban areas don’t see the daily realities associated with rural hospital closings. However, it only takes a drive and a chat with rural community members for the picture to come into focus. We are truly in a state health crisis.

Tennessee ranks top 3 in the country per capita for rural hospital closures. The state has lost 8 hospitals since 2018 and even more are in danger of closing. Tennessee ranks among the bottom 5 states in the country for overall healthiness. The opioid crisis continues to devastate as there are currently more prescriptions for opioid drugs in Tennessee than there are people. Substance abuse costs Tennessee over 3 billion dollars annually and the amount of overdose deaths has increased 54% in 6 years, while heroin use jumped 37%  from 2011 to 2016.

One benefit of having 34 states expand Medicaid is there is now rich data evaluating the results of accepting federal dollars to strengthen a state’s healthcare network, in comparison to the worsening health care outlook in states that have refused expansion.

We now know that in states that expand Medicaid, hospitals are 6 times less likely to close. In similar states, African American infant mortality rates decreased more than 14%, greater than twice the decline-average for non-expansion states. Studies report that people gaining access to affordable healthcare services and insurance through Medicaid expansion has lead to reduced medial debt, greater access to care, greater financial security, improved affordability of care, increased utilization of care, and improved self-reported health.

But people who won’t qualify for Medicaid after it’s expanded also benefit. With less uncompensated care in the state, premiums and deductibles are lower for people on private insurance and hospitals and treatment centers can focus on providing services rather than simply keeping the lights on.

Everyone benefits when more people have access to care. 

People with disabilities are significantly more likely to be employed in states that have expanded Medicaid because there is more access to economic opportunity and affordable care. If the state is interested in a stronger and larger labor force, lower premiums for private insurers, less uncompensated care in hospitals, and industry growth and revitalization in rural communities, then it should accept our federal tax dollars to expand Medicaid.

Tennesseans know how vital hospitals are to community economies across the state and it is essential they also understand the solution remains guarded by our legislature. As Medicaid varies state-to-state, with states deciding who they will offer coverage to, many Tennesseans are confused about who can and can’t qualify for state health insurance. Increasing public knowledge about who can currently qualify for TennCare would be a great place to start.

It is unacceptable that working people do not have access to affordable health care. Because they can’t get the care that they need, it makes it more difficult for them to keep a job. It is inevitable that everyone at some point in their life will need care, but having people walk into emergency rooms or county hospitals without a card in their pocket is not.

Stay tuned to learn about a campaign led by TJC and how Tennesseans are working hard to make Medicaid expansion a reality in Tennessee.