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.
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.
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.
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.
On a day reserved for the remembrance of first responders and victims of the 9/11 attacks, many of whom also lost their life…
A day where American servicemen and women are thanked for their service in two wars that followed those attacks…
The man who is one heartbeat away from the helm of state government here in Tennessee had this to say.
Its unfortunate that a political leader would use such a solemn occasion to launch a petty and misguided political attack.
In response, Tennessee House Minority Leader Craig Fitzhugh issued the following:
“September 11th is a day when all Americans come together to remember a solemn occasion in our history. Instead of honoring those who gave their lives 12 years ago, Lt. Governor Ron Ramsey decided to take the low-road and accuse our Commander-in-Chief of allying with the very terrorist who attacked our country.
“This divisive rhetoric dishonors the memory of those who died on this day. It is insulting to our President, to Senator Corker who shares the President’s position, to all Americans no matter their position on Syria and to the memory of those we’ve lost. Lt. Governor Ramsey is either grossly misinformed or he has decided to be a partisan, instead of a patriot. He should apologize immediately.”
Not to be outdone, the Chair of the TNDP also made a statement, as reported by Michael Cass of the Tennessean:
“”Speaker Ramsey should fire whoever wrote such an outrageous, dishonest, misleading, incendiary, unpatriotic and dangerous attack on our nation’s president and on Republican leaders like Senators Corker and McCain and House Speaker Boehner and even the military leaders working with them,” Herron said in a statement. “Many of us are unsure about how to proceed in Syria, but whoever wrote that tweet dishonors the victims of 9/11 and our military men and women who are doing all they can to stop more children and parents from being gassed and killed.”
He should fire someone? That’s where that tweet leads you? Holy Mackerel!
Kind of a weird thing to say in the same week three staffers announced their exit from the party offices.
In any case, Lt. Gov. Ramsey’s statement is shameful. It touches on all the things that make people’s ears bleed when they think too much about politics, and go down a road that is unnecessarily divisive on such a day as today.
Kudos to House Minority Leader Fitzhugh for calling Speaker Ramsey out.
As for the TNDP statement…
The one thing Tennesseans can take to the bank is that the GOP led state legislature focused on just about everything except helping them take more to the bank through economic development or reducing healthcare costs.
The one thing the legislature did focus on was legislation intended to further the ideological aims of those who seek to send public money to private companies en masse. The school voucher bill, a top priority for the Haslam Administration, died when a certain Senator from Germantown wouldn’t let go of his designs on upping the ante.
Another school related bill suffering the same fate was House Speaker Beth Harwell’s pet project, an expansion of the state charter authorizer…an outright dig at the Metro Nashville School Board, who thwarted a charter operator over the ruling of the State Dept. of Education in the fall.
One final school related bill that did make it out of the contentious final days was a bill that allows “for-profit” organizations to operate charter schools. This bill happened so late in session, and among so many other things that I had to call the Senate Clerk’s office to confirm that it had been passed as the vote hadn’t been updated on the General Assembly website. As a side note, they were very helpful and tracked down the vote for me in mere minutes. Good job on that.
There were several bills that dealt with different kinds of justice. One such bill, which was actively pursued by Lt. Gov. Ron Ramsey, would have changed the way judicial districts were drawn in the state and reduced them by two. That bill failed Friday in a battle of wills. There’s no word as to whether it will come up again next year, as petitions for judicial elections will be released near the beginning of session.
While people expecting speedy justice from the judicial branch were spared, others were not so lucky.
Abused animals to the brunt of legislative beatings in the passage of a bill that would make it harder to document animal abuse.
Workers seeking justice for their injuries were injured when the legislature approved changes to the workers compensation system that further tilts it against them.
Municipalities seeking to ensure workers employed on government funded jobs likely took a hit to their bank accounts as a bill seeking to overturn local living wage ordinances made its way to the Governor.
People living on fixed incomes, especially those who were likely poor to begin with, may hunger for a change as they see one of the most popular programs anywhere cut. Meals on Wheels, the popular program that helps poor elderly people eat, got cut $2.3m because the state’s “rainy day fund” was more important to the Governor and Legislature than elderly people that can’t get around on their own.
And finally, property owners, seeking to, you know, make the rules regarding what is or isn’t allowed on their property, a foundational concept of common law, will now have to allow the storage of guns in vehicles by permit holders. Its like a liberty vs. liberty deathmatch.
One good thing on the legislative front. The Shelby County Public Defender’s office did receive additional funding from the state to bring them closer to parity with other smaller PD’s. Don’t think this was kindness. Chances are, the state would have been sued by the County if this hadn’t happened.
Taking a cue, perhaps, from his from his brother’s business practices, Gov. Haslam sought to bully the Feds into acquiescing to his less kind, less expansive form of the much touted but barely formed “Arkansas Plan” for Medicaid expansion. While the language may have been the normal flavor of milquetoast we’ve come to expect from the Governor, make no mistake about it, he was pandering to the far right wing of his base.
In an article in Saturday’s paper the Governor give a quick “post-mortem” of the session saying:
“I do think there was a lot accomplished,” said Haslam. “We passed a great budget that cuts taxes, adds to the Rainy Day Fund, gives a raise to employees, has really one of the largest increases for K-12 (school) funding that we’ve had in a long time and gave a significant amount of capital (construction funding) for higher education.
“And some significant legislation passed: one of the key issues I think is increasing access to and controlling the costs of higher education … allowing more families to afford college.”
I both covered and predicted this would be a post-session talking point. For a good explination of just who benefits from the tax cuts, check out paragraphs 6-8 at this article in the CA. Pretty sure you won’t find your income on the list.
Finally, in a dig to professional development in the state, the Governor closed 34 carreer centers statewide despite the unemployment rate increasing to 7.9%. I’m sure this money ultimately goes to business tax cuts somewhere, I just haven’t found it yet.
While the worst may not have happened, this time, there’s still next year, and plenty of GOP majority to push it through. The State House and 17 State Senators, along with the Governor will be in campaign mode as they push to the November election. Expect lots of pet projects to come up again, and less strife between the House and the Senate as they push to get back to their districts as soon as possible so they can amass the cash needed to try and win another trip to Disneyland on the Cumberland.
In the mean time, take a breath and know you’re safe for a few short months…assuming, of course, the Governor’s Administration doesn’t go full on Rick Scott on us.
After this session, I’m not ruling anything out.
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.
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.
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”.
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.
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.
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.
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.
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.
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.
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.
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.
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?