Dec 03 2013

I hate to say I told ya so #TennCareExpansion

Posted by Steve Ross in State Politics

Republicans hate Obamacare so much, they’re willing to let you die to prove how bad it is.

Back in March when Gov. Haslam announced the state would not be expanding Medicaid, I wrote a series of posts about the impact of this decision on rural hospitals.

Seems like my early predictions are coming to fruition.

In his March release, it says he’s announcing the “Tennessee Plan” which was supposed to be something like the Arkansas Plan…but different. Unfortunately, this was…at best a fib. The Governor hasn’t released any specifics of the “Tennessee Plan” to the Feds, and as such, the plan doesn’t exist anywhere except in the Governor’s imagination.

In the eight months since the announcement, there’s been a bunch of nothing from the Governor.

Budget talks in November revealed what folks call the “woodworking effect”…or what happens when people start actively looking for insurance only to find out they qualified for Tenncare all along. That “effect”will be a budget buster to the tune of $172m for the author (Gov. Haslam) of the state’s largest budget to date.

It’s important to remember…these aren’t people who suddenly qualify for Tenncare…these are people we should have been covering all along.

As the year comes to a close, we are starting to hear about major cuts to rural hospitals, most of whom are the only lifeline rural families have. These cuts are just the prelude to closures, that will mean rural folks will not only NOT have access to coverage, but likely die in an emergency because needed care was too far away.

A tale of two states

Our neighbor to the north…Kentucky, is both running their own exchange and expanding medicaid. Kentucky has been in the spotlight of what the Affordable Care Act, AKA “Obamacare” is supposed to do and be…a way for all people to get health insurance coverage that is within their means.

A recent article in the Indianapolis Courier-Journal could have just as easily been written about the differences between Kentucky and Tennessee. In fact, it practically is.

Both Gov. Haslam (TN), and Gov. Pence (IN) both want to embark on Medicaid expansion in a way that would mean working poor people would have to pay for some of their healthcare costs…which means that suddenly someone making 101% of poverty would have a whole lot more out of pocket expenses than someone making just a few dollars less a pay period at 99% of poverty.

There are over 500,000 people not currently enrolled in Tenncare that live in households making $25,000 or less (133% of poverty) in Tennessee. That’s a lot more than the 330,000 predicted to come on line under Medicaid expansion. The difference is the impact of the woodworking effect.

Gov. Haslam and Gov. Pence want these people to pay more for two reasons:

1. It will cost them less making them seem more fiscally conservative, even if they aren’t.

2. They claim it will keep people from “taking advantage of the system” and add some “personal responsibility” to the program.

That’s a slap in the face to working folks…to assume that they would game the system just because they “could”. Working folks don’t have time to game the system, they’re too busy working.

It IS about people

This is about people…people who live all over the state.

People who live in remote areas because that’s where their work is. Farmers, businessmen and women, children and the elderly…people just like us city folk…that just happen to live in the country.

Over half the state’s population lives in Tennessee’s mostly rural 80+ counties. That’s a lot of ground to cover for the 3.4m who don’t live in Tennessee’s big 5 counties (35% of the population) or the other 10 with a healthy rural/urban mix. But not living in one of the state’s largest counties doesn’t mean people should be without a hospital…and due to the economic realities of providing rural healthcare…that’s the fate they face.

In a release from the Tennessee House Democratic Caucus, Chairman Turner called on the Governor to act…rather than let people needlessly suffer:

“This Christmas, Governor Haslam has the opportunity to give thousands of working men and women in Tennessee the best gift possible – longer and healthier lives,” said Chairman Turner. “I understand it will be difficult to get the expansion passed in the legislature, but the Governor owes it to the people of our state to try. If he stands by and does nothing, the hospital closures, the jobs lost, and the premature and preventable deaths of Tennesseans will rest squarely on his shoulders.”

It is a preventable tragedy. One that is so easily preventable, its almost madness that we’re even discussing people lives in such a flip manner. When Lt. Gov. Ramsey says:

“obviously this is going to hurt. In some cases there may be hospitals that have to close — but look, if you want to operate in a free market, things like that happen. But I think overall they will figure out a way to cut this.”

I’m sure the families of the people who suffered thanks to the “free market” Ramsey describes will understand.

After all, ideological purity is much more important than someone’s life.

What about Speaker Harwell? She’s only slightly more sympathetic:

There are some rural hospitals that will be hurt; there’s no doubt about that. But the health care industry is a changing industry and those that can’t keep up, they just simply can’t,” she said. “I’m sorry that that might happen, but again, if it was a little exaggerated, we’ll find out in the next six months.”

As for Governor Haslam…he hasn’t compared the human cost to an ideological test yet…in fact, he’s done what most folks with his pocketbook do to working folks…ignore them.

A slow death spiral

The worst thing about the layoffs, departures of services, and eventual closures of rural Tennessee hospitals is that it will be a slow decline…much like what many rural communities have already seen as businesses leave their communities and their populations age.

Hospitals are community pillars. They are institutions that help hold up the towns they serve. As they close…and they already are, the towns they serve and the people around them will suffer health related challenges…and economic challenges as the jobs the hospitals once hosted also disappear…and along with them, their trained, well paid workforce.

Ramsey, Harwell and Haslam will say I’m exaggerating…but its already happening…just not all at once. The slowness of it all will give them time to shift blame, distort reality, and manufacture scapegoats.

Hopefully people won’t fall for that.

Just look at Kentucky.

The irony is…the largely rural districts that vaulted them and their Republican colleagues into power…are the ones that will suffer most.

That suffering means more tragedies…and preventable decline for communities that cannot afford to bear them.