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Yesterday, the House Government Operations Committee recommended passage of HB0261 aka The Oliver Twist Act.

The bill, if passed and signed by the Governor, would reduce payments to families on certain government assistance if their child does not meet state educational standards.

Yes, there are provisions for intervention, including tutoring and parent-teacher conferences, but that doesn’t take away from the reality. The State Legislature is considering a bill that would financially punish certain families that are already experiencing hard times, for the educational challenges of their children.

No, this is not a joke.

The bill has garnered some national attention. MSNBC’s Melissa Harris-Perry did a segment on her show this weekend about it, as did Martin Bashear on the same network. The Huffington Post sounded the alarm back in January.

The Daily Show covered the issue last night. Pretty dead on coverage.

More than just the wrong message

The author of the bill claims it would “break the cycle of poverty”. I’m not sure how reducing assistance to underemployed families accomplishes that, but even still, the potential financial penalties are not nearly as bad as the message the bill sends in a time when the state’s unemployment is in the upper reaches of 7% and wages haven’t recovered to pre-recession levels, especially for the working poor.

And that’s who receives this kind of assistance, people who work, but due to the number of hours available or other market driven pressures, don’t make enough to survive without assistance.

It says to these people, who are trying to get back up on their feet, here’s a stick, I’m not afraid to use it.

And it puts undue pressure of children, who are likely already under a great deal of pressure due to their family’s circumstances. It tells these children that if someone else deems their best isn’t good enough, that their family will suffer.

It doesn’t matter if there are interventions, or if the amount were considered negligible. It is a financial penalty, and one that would require school districts to report test results to another state agency, not to mention keeping up with who does and who doesn’t receive this kind of assistance.

Insult to injury

Tennessee has 1,091,100 people living in poverty. That’s nearly 17% of the population. 442,000 children, 24% of the child population in Tennessee lives in poverty.

Both numbers are well above the national average.

You have to ask yourself, with all this struggle and suffering, why on earth would anyone think another financial setback would help someone right their ship?

Thus far, no one has been able to answer this question. The reason, they can’t.

Sacrificial lambs

For all the talk of the Tennessee economic miracle that has been trumpeted by our Governor since last year, the reality for the over one million Tennesseans in poverty, and the 1.5 million people (23%) more who are one paycheck away from being completely destitute is anything but a miracle.

Their reality is one financial crisis away from being a nightmare.

Some miracle.

Missing Opportunities

Where are the opportunities to flourish, to thrive? Where is real investment in education, jobs, infrastructure? You know, the things that built the middle class and made our country great!

You won’t get it from these folks. All they see is saving you $3.65 on sales tax a year, while they give huge tax breaks to the ultra-wealthy, and corporate handouts to companies that aren’t really employing Tennesseans in the first place.

This is the same group of people who have done everything in their power to keep anything that might help regular working people from actually helping.

They turned down billions of dollars for working people to have access to healthcare, that didn’t send them in the poor house because they didn’t like the idea of having to 10¢ on the dollar…eventually.

To date, the state has collected over $127m MORE than they thought they would…and we’ve still got four months of this fiscal year ahead of us.

$127m more and they can’t see the benefit of keeping 54 hospitals that care for working people up and running at current capacity…which means not only keeping the jobs we have, but also adding thousands of more jobs.

$127m more and they think that creating a punitive system that punishes children and families is a good way to increase educational outcomes.

$127m more and they haven’t invested one red cent in the people who could actually benefit from it. They’ve arbitrarily cut spending across the board, damn the consequences, and in the process, seen a net increase in poverty statewide.

Why have they done this?

They’ve done this, not because they thought it was the best thing for the people, but because they felt it would score them political points. Because they think you aren’t paying attention.

Its sick, and disgusting. And this bill, to take money away from families that are already struggling…and working. This bill, if anything, is the most clear example of the way they think about working people, and how they operate…in the best interest of their ideology, rather than their constituents.

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See also: The Greatest Poverty is Resentment
Suffer, Little Children
Dismantling the American Dream

Human progress is neither automatic nor inevitable… Every step toward the goal of justice requires sacrifice, suffering, and struggle; the tireless exertions and passionate concern of dedicated individuals. – Dr. Martin Luther King Jr.

Forty-Five years ago today, Dr. Martin Luther King Jr. was killed by an assassin’s bullet as he stood on the balcony of the Lorraine Motel in Memphis.

King came to Memphis in support of a sanitation strike brought on by low wages and horrific working conditions that led to the deaths of two workers.

By 1968 the United States had passed the Civil Rights Act, the Voting Rights Act, and a package of reforms dubbed Great Society which sought to eliminate economic and racial injustice.

Despite the passage of these reforms, there were still many roadblocks to African-Americans in particular and the poor generally, receiving equitable treatment and access to opportunities that would help them overcome their circumstances.

In the final days of King’s life, he worked to organize a Poor People’s Campaign in search of economic justice not only for African-Americans, but for all of our nation’s poor.

The struggle of the Civil Rights Movement, which was born of a desire for equal rights, came to include the ideas of economic justice. It is a struggle that continues to this day, not only in Memphis, but around the country and impacts all of us.

The Struggle Continues

“An individual has not started living until he can rise above the narrow confines of his individualistic concerns to the broader concerns of all humanity.” ~Martin Luther King, Jr.

Over the past forty years we’ve seen the fruits of King’s leadership come under consistent attack. Sometimes in ways that are hard to recognize.

The list of incremental changes over time is too long to even attempt to compile in one place, but laws that seek to limit people’s ability to exercise their rights, like the Voter ID bill, and efforts to hamper people’s ability to seek justice, like the Tennessee Civil Justice Act of 2011, which limits a company’s financial liability, have become the norm rather than the exception.

Yesterday I wrote about the value of work and how the notion of work has been turned on its head in recent decades. I wrote about a bill before the state legislature that would make it harder for people hurt in the actions of their work to be taken care of.

This kind of injustice is exactly what Dr. King fought against in his later years. In the years since his death, the concerted effort of one group to limit the access to justice has become commonplace both here in Tennessee and across the nation.

An Organized Assault on Justice

“He who passively accepts evil is as much involved in it as he who helps to perpetrate it. He who accepts evil without protesting against it is really cooperating with it.” – Martin Luther King, Jr.

Over the past forty years, there has been an organized assault on the ideas of economic and social justice.

This effort has taken many shapes, and been played out in many venues…from school boards to legislatures at the state and federal level, as well as everything in between.

It is well funded, and organized for a single purpose: to further tilt the playing field in support of those who have plenty and seek to accumulate more, in opposition to those of us who are seeking to simply make a life for our families.

Newscoma wrote about one such group, ALEC an organization that crafts model bills that are personalized for each state. As she notes in her post, we’ve had several of them.

These bills, which have been labeled “conscientious reform” by supporters, seek to make holding people accountable more difficult, especially when they have more resources. They represent an attack on economic justice for people who have few resources to fight for themselves.

By and large, there have been few organized attempts to bring light to the impact these bills would have on regular people. The struggle has been fragmented while the attack has been organized. The end result has been a steady erosion of justice by limiting access and stifling accountability.

Education: Divide and Conquer

The function of education is to teach one to think intensively and to think critically. Intelligence plus character – that is the goal of true education. – Martin Luther King, Jr.

The cause of true education, as King describes it, has been under attack by forces seeking to cripple public education for the past two decades. An increased focus on testing has led to curriculum focused on teaching to the test rather than critical thinking and problem solving skills that empower people regardless of their chosen profession or trade.

While the effort began before the passage of No Child Left Behind, this bill had a devastating effect on education by forcing educators to focus on rote memory rather than broader ideas of personal development.

The philosophical foundation of the act ultimately makes learners “consumers of education” rather than active participants. True education can no be based on a passive “consumerist” model. Students must be active participants engaging in a dialogue to truly gain the “intelligence plus character” that Dr. King mentions.

This notion of consumerism is furthered in legislative efforts that have followed.

The concept of “school choice”, either through transfers, charter schools, or voucher programs, resonate with parents seeking to give their children the best opportunity to gain a quality education. This idea is based on this same consumer model predicated on personal resource availability, time, transportation, and money, that, by default, exclude those who lack resources.

In Tennessee, bills seeking to hobble teachers unions, state nullification of local charter school decisions, school voucher programs, and stiff economic penalties for the poor who do not meet state educational standards, AKA “Starve the Poor” bills have made, and are making their way through the state legislature.

These initiatives seek at once to reduce investment in education, place public dollars in the hands of private entities that are largely unaccountable in the public sphere, and most importantly, distract from the economic circumstances brought on by decades of economically unjust fiscal policy in the service of wealth concentration for the mighty few rather than opportunity for the common good.

This is similar to Dr. King’s opposition to the Vietnam War, which sucked resources away from domestic programs, and led to a global financial showdown that paved the way for the trickle down economics that would dominate the 1980′s and begin a trend of wage stagnation that continues to this day.

Reclaiming the Dream

The righteous care about justice for the poor, but the wicked have no such concern.
PROVERBS 29:7

Dr. King’s work is most closely associated with social justice and racial equality, particularly through his I Have a Dream speech. But his legacy cannot be defined by that one awe inspiring event.

Dr. King’s vision went beyond the struggles of his day, and is owed the consideration of his later efforts, including those that led to his life being cut tragically short here in Memphis.

His later work focused on the broad ideas of justice and were targeted at helping the economically disadvantaged.

I think it was and still is difficult for people to understand the potential outcomes of this effort.

While focused in the south and primarily on African-Americans continuing their struggle for equality, his work didn’t just apply to one race, but to all who fell under the grip of poverty. I feel confident that over time this effort would have expanded to poor white coal miners in West Virginia, and migrant workers in California.

We never got to see what would come of Dr. King’s leadership on economic justice. His life and work was cut short.

We can continue to take cues from his leadership, and push on, continuing the struggle, through out tireless exertions and passionate concern, dedicated to the service of justice.

In fact, we have a duty to that very thing.

Over the past several days I’ve been writing about Gov. Haslam’s decision on Medicaid expansion. While this has been going on, a bill, supported by the Governor, has been steamrolling its way through the state legislature. A bill that would further shift power away from workers and workplace protections by creating new hurdles for people hurt in the workplace.

On Monday, the State Senate passed their version of HB 0194, a bill that would create a new mechanism for workers to receive compensation while hurt on the job, and reduce their rights even if the injury was through no fault of their own.

The bill is currently in the final stages of passage in the State House.

The proposed changes dramatically shifts the burden from employers, who have a duty to provide a safe work environment, to the government and employees.

What’s more, it creates a new special judicial system, administered by the State Dept. of Labor, which was recently reported to have grossly mismanaged the Unemployment Insurance program to the tune of $73m.

You may recall, the head of that department recently stepped down, just days before the announcement of this report, following a trend of Haslam appointees who have resigned due to poor management.

This trend of mismanagement follows another trend of “worker reforms” that began with the limiting of collective bargaining for teachers, among other efforts.

Through the Governor’s support of these bills, he has sought to do what so many other GOP leaders seek, to tilt the balance in favor of business under the rationale that it will be good for workers. This of course, couldn’t be further from the truth.

Work, an American Value

One of the values that Americans hold dear is the idea that hard work will be rewarded with a certain measure of success.

I think we all understand that not everyone will be Warren Buffett rich, but we have a national expectation that your work will not be in vain. An idea of “merit”, that hard work has value.

This is an idea that starts before our revolutionary beginnings, continued during our early westward expansion, carries its way through the the gilded age, the Great War, Great Depression, WWII and to this very day.

Its an idea expressed in the writings of Horatio Alger through books like Ragged Dick, the story of a poor worker who rose to the Middle Class. Something that was not very easy in the late 1800′s.

Over the years we have romanticized these rags to riches stories. They have become a part of the mythology of America. An oral history that, like most tall tales, has been exaggerated over time.

The stories of early industrialists, like Andrew Carnegie, who started working at age 12, and through the course of many years of hard work and helpful benefactors became a real life example of the mythology of merit.

While there’s no question about Carnegie’s humble beginnings, particularly in comparison to his ultimate wealth, the reality is, without the help of a great many people, who steered him to the right investments, helped him raise capital to build his empire…not to mention some of his more cut-throat practices against investors, labor, and anyone else that stood in his way, he would not have risen to the level of wealth he eventually acquired.

The forgotten reality is that hard work doesn’t necessarily make you rich. It can help make you “not poor”.

Birth of the Middle Class

In the post-WWII era, the combination of increased business regulation, government spending on infrastructure, and compulsory education that began during the Industrial Revolution led to the creation of a robust middle class in America.

I think we like to believe that a large Middle Class has always existed in this country. That couldn’t be further from the truth. If it were so, works like Upton Sinclair’s The Jungle wouldn’t have had the impact that they did.

The premise of the book was, at first, derided by the administration of Theodore Roosevelt, who called Sinclair a “hysterical crackpot”. Upon further inspection, Roosevelt’s view of the work evolved, culminating in the first real labor reforms of the 20th century.

In the wake of the Great Depression, which was brought on by wild speculation, among other things, more worker reforms were passed like the National Labor Relations Act (NLRA), which acknowledged that in wage negotiations, capital had the upper hand. Take it of leave it is not a negotiation. In order to level that playing field, NLRA allowed workers to band together and bargain as a group for the common good.

It is interesting that the rise of the middle class, and unions came hand in hand, though that shouldn’t be surprising. The Treaty of Detroit, one of the first large victories of labor, led the way to workplace reforms that became the standard both in the marketplace, and eventually Federal law.

While there’s no question that the overall economy during the post WWII era (1946-1965) had its ups and downs, overall, people benefitted from the collaboration of labor, capital, and government, as income became more evenly distributed throughout the workforce.

Devaluing Work

One of the most stunning contradictions of the past 40 years is the way we have come to revere work while deriding labor. It is a mindset that says that some work is more important than other work.

I have a difficult time with this idea.

From my perspective, the most important work is that which I have no desire to do. Things like trash collection, construction and farming, public safety (police, fire, EMS) or teaching for that matter. These are jobs that are necessary for our society to function, grow, and thrive, but the reality is, no one is getting rich doing any of these things.

You wouldn’t know that to hear some tell it.

In recent years, the push to crush labor has taken many forms. From the first truly successful assault in 1981 with the firing of air traffic controllers to more recent efforts, like those in Wisconsin and Michigan to cripple labor through “right to work” laws.

Full Circle

While the value of work in the American psyche and ideas of merit have gone largely unchanged over the past 40 years, the reality for workers has gone through a massive transformation.

As the chart to the left shows, real wages have remained largely stagnant for workers in the United States since 1989. The reality is, its been going on longer than that.

All the while, the very people who have sought to shift the balance of labor from an equal playing field, to one that places greater importance on “job creators”, have, at the same time, used the rhetoric of bootstraps and hard work to fool voters into believing their ideas are somehow going to benefit them.

The reality couldn’t be further from the truth.

In every measurable way, the effort has resulted in a race to the bottom for average people while a very few benefitted the most.

This is not merit, as most Americans understand it, but a value judgement that puts a wealthy few above those who actually do the things that move our economy along.

It is an injustice, that hasn’t been committed by a few small acts, but a systemic and concerted effort over the years.

That injustice, and the fight against it will be the topic of tomorrow’s post.

A couple of years ago, when I first published this image, I was lauded as a “chicken little” by some of my more conservative friends. They asserted that I was crying about the sky falling before a single drop had landed on my quickly balding head.

With a little time for reflection I say, “How do you like me now?”

Since last Wednesday’s decision to forego the expansion of Medicaid, and over $1b in Federal funding to do it, lots of people have sounded off on the issue. One of the best mashups of coverage came from Tennessee Values Authority over the weekend.

Pulling information from national and statewide sources, TVA shows in pretty stark terms the reality behind the rhetoric that the Governor used, to try and paint the Federal Government as inflexible and unwilling to compromise.

The Governor followed the lead of most other southern GOP lead states in effectively denouncing that favorite whipping boy of the Obama Administration…Obamacare. However, that wall isn’t as solid outside of the South. Maine is reconsidering, and seven other states with GOP Governors have accepted expansion.

This is one reason many thought Tennessee would be the next to break ranks.

Living in a dream world

In his address, the Governor invoked the “Arkansas Plan” as a model he hoped to pursue…with some tweaks.

The “Arkansas Plan” is an idea, still in the incubation stages, that would purchase private insurance through the state-run exchange for people, and include Medicaid “wrap-around” coverage.

But Gov. Haslam isn’t seeking to duplicate the idea of the “Arkansas Plan”. In fact, there are two stark differences between what Haslam proposes and what Arkansas proposes.

1. Arkansas will provide insurance to Medicaid expansion recipients with the same level of service as other Medicaid recipients. Gov. Haslam seeks to ask people to make co-pays above and beyond what Medicaid allows. This is likely in search of driving down premiums, but not actually serving more people.

2. Arkansas is running its own healthcare exchange, Tennessee is not. So Arkansas has more flexibility in terms of the market it will be seeking to provide services in. Tennessee locked itself into the Federal exchange back in December.

It should be noted, the “Arkansas Plan” has only been approved in concept, not practice. Arkansas will have to gain final approval from the Feds before they can head down this path.

In essence, Gov. Haslam has sought to make a modification to a plan that has only been tenatively approved, by adding things his administration knows full well would not be approved, and then saying “all or nothing”.

Haslam reported today that HHS head Kathleen Sebelius said “We want to work with you”. Of course, that doesn’t mean, “we’ll give away the farm”, which is what Haslam actually wants. So, nothing has changed.

In the end, this is not a good strategy if you want to get something done. Great strategy if you’re playing to a base that doesn’t like the idea in the first place.

Electoral Strategery and governance

Truth be told, Gov. Haslam is politically stuck between a rock and a hard place. On the one hand, he has his moderate image that helped bring him widespread support across the state. On the other hand, he cannot exert the same Executive authority as 44 other Governors, whose states require a 2/3 majority to override a veto.

His decision on Medicaid Expansion is part of a strategy that would allow the Governor to “save face” with Conservatives, while looking reasonable to his moderate base. What’s more, it plays into electoral politics and is hoped to hold back a primary challenge from the right. Something the Governor might not survive if the ultra-conservative wing of the GOP has a single standard-bearer to rally behind (Haslam received 47.4% of the votes in the 2010 August Primary, not a majority).

Another reality is there is little possibility the legislature would approve expansion anyway, so why risk the political capital? A bill sponsored by Sen. Brian Kelsey (R-Germantown) to prohibit the state from participating in Medicaid Expansion, has sailed through committee and currently stands in final stages of approval. The bill was opposed by the Haslam administration, but still likely had a hand in the final decision on Medicaid.

The legislature must do something to approve expansion, as it requires accepting and spending Federal dollars. Considering all these variables, from a political perspective, there wasn’t much the Governor could do, despite the support of the Tennessee Chamber of Commerce, the Tennessee Hospital Assn., the fears of Hospital CEO’s, whose patients Lt. Gov. Ron Ramsey is willing to sacrifice as victims of the free market even in rural areas which the majority of his caucus represents.

Despite those apparent challenges, the Governor could have shown some leadership instead of trying to deflect blame and come out in support of the idea, even if the nuts and bolts weren’t worked out. In doing so, perhaps some members of the GOP caucus would have given him the latitude to still uphold the Hastert Rule and Reagan’s 11th commandment, the only two rules that seem to matter in GOP politics.

I know, its asking way too much.

Yet Another Slow-Motion Apocalypse

Over the course of the past several days, I’ve sought to chronicle what will likely happen to rural communities as a result of this decision. The posts will be linked below, but in simple terms, this will be economically devastating.

Over 9000 rural jobs hang in the balance, with a direct economic impact of over $400m in actual wages lost in those areas…not to mention other jobs that will be lost in the area due to decreased demand and spending.

But the impact isn’t limited to rural counties…though it will have a far deeper and wider impact there. Hospitals in the state’s largest counties, Shelby, Davidson, Knox, and Hamilton all are impacted, bringing the total employment impact to 21,000 jobs lost.

This, after several economists predicted an increase of around 8000 jobs by 2019. Not a huge number, but better than potentially losing 21,000.

And so we find ourselves stuck between policy and politics once again. Its become a common thread in recent years. The end result, hard working people lose.

God knows, if ever there was time for a candidate that actually gave a damn about the folks who do the work that actually gets things done, that time is now. But they must get out there and start doing, rather than just talking. Talking and not doing is what got us into this mess in the first place…and it started well before Democrats started losing seats en masse in 2006.

Nationally Lampooned

Finally, I would just like to leave you with this video, that you’ve probably already seen, from the Colbert Show. Honestly, no one could have said it any better.

Previous Posts on Medicaid Expansion

Medicaid Expansion: Is there a downside?
Bill Haslam’s Death Panel
More on the Haslam Death Panel
The Economic Impact of Hospital Deserts
Distant Care – Existing Hospital Deserts
What does Medicaid expansion actually do?

One of the things I’ve seen over and over is a misunderstanding of what Medicaid expansion is, and in turn, how it would impact both people and providers, including hospitals, if enacted.

To get there, we have to first understand what Tennessee’s system does now, how efficient it is, what changes would come under expansion, and finally, what changes are coming no matter what happens.

To that end, you might ask…

What is TennCare?

Here’s a description from the State website:

TennCare is the State of Tennessee’s Medicaid program that provides health care for 1.2 million Tennesseans and operates with an annual budget of approximately 8 billion dollars.
…
TennCare is one of the oldest Medicaid managed care programs in the country, having begun on January 1, 1994. It is the only program in the nation to enroll the entire state Medicaid population in managed care.

Most of us are familiar with HMO’s, in essence, that’s how TennCare works, though the premium is funded via the Federal and State government.

You can see just how much of TennCare is funded by the State and Federal governments by clicking here and navigating to page B-154, which lists state and federal appropriations for the past three years. Here’s the distribution for those years:

You’ll notice that in 2010-11 the federal government’s portion of funding was 3 times that of the state.

In the years since, including next year’s projected budget, that ratio drops to 2:1.

This is due to the American Recovery Reinvestment Act (ARRA), which increased the Federal government’s contribution to help save TennCare from huge budget cuts.

You’ll also note that in the coming year, TennCare appropriations increase by nearly $900m.

This is likely, to help cover normal increases in healthcare costs as well as the nearly 100,000 people in Tennessee that qualify for TennCare , but are not on the rolls due to enrollment caps, or simply not knowing they’re eligible. This is required by ACA to receive Medicaid matching funds.

As the individual mandate comes on line in 2014, these people will finally gain access to something they should have been able to use for years.

A Case Study in Government Efficiency

There are lots of people out there that are convinced Government cannot provide services more efficiently than business.

Some of this is due to the nature of government, which provides services, like road construction, for the common good, knowing that the initial cost may eventually be covered by increased efficiency, but the ongoing maintenance costs may not.

Imagine where we would be as a nation without our network of Interstates and Highways. There’s no way private business would invest the capital necessary to accomplish this with the efficiency of government. Our highways would be a patchwork of spaghetti serving the interests of those private businesses rather than the common good.

TennCare is very similar to this example. It is more efficient than any other insurance delivery method. Last Wednesday, after Gov. Haslam announced his intention to not expand Medicaid in Tennessee, lots of people found lots of reasons that was a bad idea. One of the better arguments is the efficiency with which TennCare currently provides insurance to those in need.

According to the state government’s TennCare budget report, not only is the government more efficient, costing half of what private insurance costs per person, but it also manages inflation better, holding it to half of National Medicaid inflation, and more than half of commercial insurance.

This is one reason Gov. Haslam’s insistence on using expansion dollars to purchase private care for individuals doesn’t make much sense, but we’ll cover that in the next post.

Understanding Uncompensated Care

Medicaid was created to cover people who don’t have the money to purchase health insurance. The expansion of Medicaid helps cover those who couldn’t even purchase health insurance with financial help from the government. Currently, Medicaid only covers people in poverty, and children, depending on age, up to 133% of poverty.

In the past this meant many families earning between the poverty level and as much as 250% of poverty ($59,000/yr for a family of 4) couldn’t afford coverage if it isn’t offered by one of their employers, or if the employee contribution is too high.

It creates is a huge hole in coverage of people. While folks nearing the middle income area may be able to pay out of pocket costs for doctor visits, folks down at the lower end of the scale can’t.

Full time minimum wage is 138% of poverty. I don’t know of too many places offering minimum wage that also offer insurance that’s worth the plastic the card’s made of. And at $15,000 a year, I’m not sure someone could even afford the employee contribution, or the co-pays.

So what happens is, folks in this situation go to the Hospital when things get really bad. Hospitals treat them because, unlike other areas of the economy, life is valued more than getting paid.

When the person can’t pay their bill, and proves to the hospital they are too poor to pay, the hospital calls it “uncompensated care” and gets reimbursed a portion of it from the state, through federal dollars.

Folks outside of Memphis may not remember back in 2010 when we were faced with the real possibility that our public hospital, The MED, might close due to unusually high rates of uncompensated care.

Commissioner Mike Ritz (R? – Germantown) led the charge, alleging the state had not been giving The MED its fair share of uncompensated care funding. Metro Nashville General had the same problem a few years before.

Honestly, I don’t remember what came of it. But such battles could be moot under ACA where everyone is covered.

Ending Uncompensated Care with Compensated Care

Under ACA, everyone must have some kind of insurance or pay a penalty. Under the law, everyone making between 101% and 400% of poverty ($23550 – $94,000yr for a family of 4) will receive some kind of subsidy to help pay for the cost of healthcare.

That subsidy effectively replaces the amount spent on “uncompensated care”. The idea being, its better to use that money to get people in care earlier so they don’t end up using the Emergency Room as their primary care facility.

Currently, Medicaid in Tennessee provides healthcare for adults earning poverty level wages or less. What Medicaid expansion would do is cover people up to 138% of poverty or $32,500 for a family of 4.

What this expansion addresses is the reality that folks under a certain income threshold just won’t be able to shoulder the burden of the individual mandate, and, in order to make the policy work, must be extended care benefits.

By choosing not to accept the expansion dollars, at a time when uncompensated care dollars will be disappearing, the Haslam administration has put the fiscal viability of hospitals that serve poor people in serious danger. In effect, this decision punishes hospitals for their circumstances…not being in a wealthy enough community.

The Working Poor Suffer Most…As Usual

As I’ve shown in previous posts, most of the facilities in the 30 counties that could lose their hospitals have relatively high rates of poverty. In reality, every hospital that helps care for poorer people is at risk, including four hospitals in Memphis (The MED isn’t one of them), Metro Nashville, Mercy Medical Center West in Knoxville, and Erlanger in Chattanooga.

In short, in addition to endangering hospitals all over the state, this policy will hurt hospitals all over that serve poorer populations because these individuals will not be able to purchase care, due to their income, yet still need it, by virtue of being human.

The gap in compensation will no longer be covered, causing huge economic problems for these hospitals and making travel to hospitals longer for people who already have so many things stacked against them.

Based on Household income data from the Census Bureau, nearly 30% of households in Tennessee make 138% of poverty or less. But everyone in those areas stand to lose, regardless of income, as their hospitals struggle to survive under the weight of non-expansion.

And while the 15 counties without hospitals may not seem like a huge issue, it is for the folks that live there. I have it on good authority there are more who are in danger, or have already closed.

The 30 that stand to lose their hospitals, and the economic/health crisis that creates may not be compelling, until you consider the cascading effect it would have on hospitals across the state, forcing people who cannot afford care into hospitals that were once financially healthy, but due to largely political considerations, are now in danger.

That’s all thanks to the unrealistic demands of the “Tennessee Plan”, as Gov. Haslam has dubbed it. Which is the subject of my next post.