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?
That’s what the red represents in this map.
I want to direct your attention to the line of counties that cut across the state diagonally on the line between the eastern and middle divisions of Tennessee. In all, only 14 of the 33 counties in East Tennessee will be left with any hospital to speak of.
Yes, most of those counties are rural. Yes, many of them have higher than average rates of poverty. But are the people who live in these counties, by virtue of their circumstances, any less human, or deserving of care?
I don’t think so.
In his address to the State House and Senate, Gov. Haslam used a pretty standard dodge for politicians who don’t like taking responsibility for their actions…he blamed the Feds.
“If only the Feds would let us do it our way…”, he proclaimed, as though the plan he presented was somehow appreciably better than what Medicaid currently provides.
While there’s no question Medicaid has flaws, expanding it would also cover over 300,000 people. The best Gov. Haslam can do with his plan is cover just over 50% of those folks or 175,000 people.
Why does his plan cost more? Because rather than using the existing Medicaid structure for coverage, he wants to subsidize private companies with public dollars and buy care on the healthcare exchange he chose not to run.
So at once, Haslam blames the Feds for providing money to help care for people who can’t pay for it, and has the gall to say they wouldn’t let him cover fewer using a device in the law that he chose not to run in Tennessee.
Because, while there will eventually be some costs to Tennessee (we’ll get nine dollars for spending 1)…starting three years from now, there won’t be any costs now.
By now, its almost common knowledge that your chances of surviving a catastrophic health event like a heart attack or stroke are significantly increased when you make it to the hospital sooner.
A 2004 study by Cornell University quantified your chances of surviving a heart attack in this way:
Heart attack victims who make it to the hospital in time to receive medical attention are four to five times more likely to survive compared with those who don’t make it to a hospital promptly, according to a new Cornell University study. The research also finds that for each five-minute increase in distance from a hospital, a person’s probability of getting to the hospital in time falls by 1.25 percent.
For people that live in hospital deserts, the reality is, they will likely die from a catastrophic health event like a heart attack, because the distance to the hospital is just too great.
I think its hard, particularly for people who live in urban areas, to understand just how long it takes to get to a hospital in a rural area. So here’s an example.
One of the Counties that make up the border between middle and east Tennessee, Morgan Co. is a small rural area of just under 22,000 people.
It occupies a special area. Nearly every county surrounding Morgan Co. has a hospital that is on the list of hospitals in danger.
Right now, if you lived in Wartburg, TN, which is where County government is located, travel to the nearest hospital would be Roane Medical Center in Harriman, just 22 min. away.
But Roane is on the list of hospitals in danger. If it closed, the next hospital would be Methodist Oak Ridge, which is about 37 min. away.
Unfortunately, it is also on the list of hospitals in danger of closure.
The nearest hospital, that isn’t listed as being in danger of closure is Parkwest Medical Center in Knoxville, nearly 50 minutes away.
That’s a really long drive, across some very winding roads. Can you imagine having to travel for an hour to receive “emergency” care. That’s what folks in Morgan County will be faced with if the worst comes to pass.
So let’s think about this. It takes between 5-10 min for the ambulance to get there. Followed by a 50 minute ride to the hospital. Your chances of surviving have been decreased by 15% due to distance alone. That doesn’t take into account complications or other issues, and it assumes the best possible scenario.
From my home in Memphis, an ambulance is less than 3 min. away. The nearest hospital, Methodist University, is 4 minutes away, by car. 10 min. tops to get to the hospital, increasing my chances of survival by nearly 10% over me if I had the same emergency in Lake Co.
Now I’m not arguing that there needs to be a hospital 10 min away from everyone. I understand just how impractical that is. What I am arguing is, any policy that makes it harder for smaller hospitals that serve a largely rural or poor population, by definition, unnecessarily puts those people at greater risk.
It seems to me that if we could prevent it, we should, for the good of those people.
The thing that really turns my stomach about all of this is just how preventable it is. While there’s no question that some areas are going to have to travel further for medical care, by virtue of their remoteness, choosing a policy that makes areas even more remote, out of what seems to be little more than partisanship and spite is both mean and lacks the kind of compassion you would expect from a leader making decisions that could be the difference between life and death.
Gov. Haslam noted that he doesn’t like “Obamacare”. Truth be told, there are things I don’t like about it either, though for very different reasons. But we’ve been having a conversation in this country about healthcare since Richard Nixon announced his support for a kind of nationalized HMO system over 40 years ago. This is the first policy that’s been able to gain the votes to get out of Congress.
In short, like it or not, its the policy we have.
Its unfortunate that someone’s dislike for a policy would so cloud their vision as to not even present a plan that might work…if for no other reason, than to help the people of their state. But that’s exactly what the Haslam Administration did. They presented a plan that was neither efficient in terms of delivery nor cost effective in terms of covering the most people for the fewest dollars.
They presented a plan they knew wouldn’t fly, for the very purpose of pinning the blame politically on the Feds. It is both a cynical and dishonest way to conduct business.
That’s something I’ll talk more about in my next post.
Until then, Happy Easter.
One of the hardest things for me to wrap my head around is the enormity of the economic impact the loss of a hospital has on a small community.
In a state of over 6 million people, the loss of 21,000 jobs may not seem like much. It wouldn’t have a dramatic effect on the statewide unemployment rate. With over 3 million people in the workforce, the change to the state’s unemployment rate would be about .7%. That’s a lot, but absorbed over the totality of the state’s economy, its not overwhelming.When I think about 21,000 people, I have to default to my childhood home of Osceola, AR.
Nestled against the Mississippi River, in the middle of Mississippi Co., this town’s population represents about 1/3 of the people that stand to lose their jobs in the wake of Haslam’s Medicaid Expansion decision.
I lived in Osceola in the 70′s and 80′s. While I was there, I watched as people moved away due to plant closings and layoffs. I don’t remember all the specifics, but I do remember hearing my friends say they had to move because their parent lost a job.
Looking back on it, a lot of jobs were lost due to the economic times…which made it hurt even more.
The folks that left were skilled people, most with college degrees, who managed operations. Many of them didn’t have deep ties to the community. They moved there for the job. While picking up and moving wasn’t easy, it was easier than staying in a place where there was no opportunity to practice the trade you trained in.
It was a slow bleed. Locals saw what was happening, even if they couldn’t predict the long-term economic impact these losses would have on the community.
Maybe it was seeing the writing on the wall, searching for new opportunities, or a combination of the two that led my parents to move the family in the mid-80′s. But leave we did, eventually landing in North Little Rock, AR.
Osceola has lost about 15% of its population since then. Its fortunate to be close to Memphis, I-55, and the Mississippi River. The combination of those three things is probably the only thing that’s kept it from losing more people.
Almost 30 years later I understand why we left. But I also know, as the population slowly dwindles, it makes it that much harder for the people who are left behind.
Of the 30 counties that stand to lose their hospitals, 18 have workforces of 15,000 or less. Only two approach 50,000 workers, a measure that you might characterize as an urban/rural mix.
Looking at Census data, these counties have been mostly declining in population for some time as well. Some more than others. I’m sure they’ve had their fair share of layoffs and factory closures. Most don’t have much of a manufacturing base to speak of.
It’s hard to figure the real economic impact of a hospital closure on a community. Most of these counties don’t have detailed financial information readily available, which is one problem. The other is that there’s no way to know what mix of workers will lose their jobs out of those 21,000.
The best you can do is look at per capita income (Average of all earners in a county) and what the Healthcare industry publishes about wages in healthcare, then make an educated guess.
The chart below tells three related stories:
1. How much the unemployment rate would increase in each of these counties if all these people immediately lost their jobs. This is derived from unemployment and Census data that is readily available and easy to find.
2. The approximate amount of income that would be lost in each county if all of these people lost their jobs for a calendar year. This is based on market data for hospital jobs and national averages of staffing practices, then adjusted for cost of living and per capita wages in each county.
3. The last column looks at total per capita income for the county, and using the data from column 2, shows the percentage of annual income each county would lose.
Here are the key takeaways for folks struggling to come to grips with these numbers.
1. For these 30 counties, unemployment would increase by an average of 2%
2. Around $400 million dollars would be lost from income only in these 30 counties as well as the state, accounting for nearly 4% of all income in the area.
I would be willing to wager that the numbers reflected above are conservative. I can also say with a high degree of certainty that the wages lost in each of these counties only represent a fraction of the economic impact.
Economic losses ripple through a community. As more money leaves, either through job losses or relocations, local merchants and businesses feel the effects of decreased spending. This in turn forces them to make cuts to hours, which only exacerbates the problem, creating a downward spiral, that only stops when something intervenes.
It doesn’t have to be fast. It can take decades.
Another challenge is figuring out how this would happen. Some of the smaller facilities might just close in a poof. The larger ones will likely linger, slowly shedding staff until its economically unfeasible to remain in business. Some may be able to find a way power through and stay open.
Thats something I sincerely hope happens.
Hospitals are a community cornerstone. The loss of another cornerstone for some of these communities could be a tipping point. That makes me sad.
While I don’t choose to live in a rural area, I have a lot of love for the work ethic and the pride folks in rural America take in their communities. The idea of the rural way of life taking another hit due to a purely political decision makes me angry.
That anger has only gotten stronger in the past few days. As details of the pie in the sky negotiating tactics employed by Gov. Haslam have come to light, it reinforced an idea that I’ve had for some time: that Gov. Haslam, by virtue of many things in his life, is so far removed from the experiences of regular Tennesseans that he could no more relate to their circumstances than fly to the moon.
Speaker Ramsey, who I think must have played with mercury from broken thermometers as a child, just casts aside concerns, with little more than a “tough s**t” for these towns.
This makes me hurt for the folks who have poured their lives in their communities and will likely suffer under the weight of brinksmanship.
That may sound corny, but rural America is where I came from. You’ll excuse me if I feel a little nostalgic.
I won’t pretend to have all the answers, but I know that for rural communities to survive and thrive, they can’t be treated as an after-thought, or worse, without any thought to the outcomes.
Folks in rural America have strong wills and long memories as anyone whose talked to folks at a local diner or a local watering hole knows.
They know when they’ve been cast aside and forgotten.
They don’t take that slight lightly.
They’ll ever stop fighting for their communities, or forget this.