Commentary: A costly way to change the subject

Over 150 years after the Constitution was amended to promise equal rights to African-Americans and a decade after the nation’s first African-American president signed the Affordable Care Act into law, racism continues to dominate Tennessee health policy. Last week’s rush to ratify the Trump Administration’s TennCare block grant was the latest chapter in Tennessee officials’ costly, benighted rear-guard defense of racial injustice.

TennCare is our state’s version of the federally funded Medicaid program. It is impossible to exaggerate its importance. TennCare provides health coverage to 1.5 million vulnerable Tennesseans, including half of Tennessee children, two thirds of nursing home residents and the majority of Tennesseans with severe disabilities. The program benefits all Tennesseans by providing crucial funding for the health care infrastructure on which we all rely. 

The federal government funds two-thirds of the program’s costs. At over $8 billion a year, federal TennCare funding is by far the largest source of federal funds in the state budget. Those federal funds support seven different state departments, from children’s services to mental health. Federal TennCare funds supply twenty cents of every dollar the state spends. A material reduction in TennCare’s federal funding stream would disrupt all of those agencies, and the public services they provide.

A crucial feature of TennCare has been the open-ended nature of the federal funding: the feds match every dollar we spend on a 2:1 basis, with no ceiling. The new waiver alters that crucial feature, ending Tennessee’s access to open-ended federal financing and substituting a “block grant,” that caps future federal funds. The effect is to insert a potential time bomb in the state budget. It is the final act in President Trump’s four year effort to undermine the ACA and Medicaid.

It’s a safe bet that neither Gov. Bill Lee nor the Republican legislators who hastily voted to approve the deal read the complex 222-page waiver document, much less understood it. Their uninformed approval of the block grant was recklessly irresponsible.

Trump Administration officials claim the deal will afford Tennessee savings and freedom from oppressive federal regulation. The state’s new “flexibility” really means not having to observe patient safeguards and being able to cut TennCare services without federal oversight.

No other state, Republican or Democrat, has been willing to touch such a destructive bargain. The American Cancer Society and all of the nation’s major patient advocacy organizations have opposed block grants for jeopardizing the care of patients with the greatest medical needs. So, what’s in it for Governor Lee and the legislature’s Republican supermajority?

The deal burnishes Tennessee Republicans’ credentials as Trump loyalists. Most importantly, it enables them to change the subject on health policy. In 2014, disgraced Rep. Jeremy Durham sponsored a state law blocking expansion of Medicaid to 300,000 uninsured Tennesseans who are “working poor”. The expansion was funded under the ACA, which legislators vilified as “Obamacare.” The mere invocation of the name of the first African-American president was enough to ensure passage of Durham’s law. It was also enough to prompt legislators in 2015 to block Republican Governor Bill Haslam’s Insure Tennessee plan. That plan would cover the working poor at no cost to the state, using ACA funds and hospitals’ pledge to pay the state portion of costs. 

Insure Tennessee remains popular with most Tennesseans of both parties. That has put pressure on legislators, who do not hesitate to appropriate taxpayer funds to subsidize health insurance for themselves and their families, to finally approve Insure Tennessee. While Tennessee has spurned $1.4 billion in Medicaid funding annually, rural hospitals have closed and the pandemic rages. The majority of other Republican states have expanded Medicaid, further increasing the pressure on Tennessee’s GOP leadership. That’s why they so eagerly welcomed the block grant as a shiny object to distract the public from their abject failure to manage health policy in the best interest of Tennesseans.

Most working poor who suffer from state leaders’ refusal to approve Insure Tennessee are white. But because people of color are more likely to hold low-wage jobs that do not provide health coverage, they are disproportionately represented in the ranks of the working poor. Insure Tennessee would therefore reduce racial disparities in health status and protect those Tennesseans whom the pandemic disproportionately endangers.  

Our leaders, who have defended slaver and Ku Kluxer Nathan Bedford Forrest, and who met in special session last summer to target Black Lives Matter by criminalizing peaceful protest, approved the block grant knowing only that it was something Trump wanted, and that it would distract from their refusal of health coverage to Tennesseans in desperate need.

Our leaders’ folly, which continues to cost the lives of uninsured Tennesseans of all races, calls to mind the warning of Dr. Martin Luther King: “We must learn to live together as brothers or perish together as fools.”