Tennessee Deserves Better Health Reform - And Response

  • Monday, March 2, 2015
  • Brian Kelsey
Tennessee needs health care reform. Expanding Medicaid under the Affordable Care Act, or "Obamacare," was not the best solution for Tennesseans. That is why the vast majority of Tennessee legislators never publicly supported the plan defeated in a special legislative session in February.
 
It is important to distinguish health care from health insurance. As one physician who supported Medicaid expansion told me, "No one is claiming that more people are dying in Tennessee than in Kentucky because Tennessee did not expand Medicaid." He continued, "Thankfully, there is a safety net in America for people without health insurance to receive health care."
 
The question then is, "Who should pay for that health care?" Obamacare paid for expanding Medicaid in part by cutting Medicare payments for seniors and by cutting payments to hospitals.
 
Some are saying that decreased payments to hospitals may cause a county tax increase to support the Regional Medical Center; however, these cuts do not take effect until 2017.
Washington caused this problem, and Washington should solve it.
 
Tennessee, unlike Washington, must balance its budget every year. If Medicaid expansion had passed in Tennessee, state taxpayers would have been left on the hook to pay for this new entitlement.
 
That is why I have proposed an alternative three-point plan for health care reform in Tennessee: 1) allow Tennesseans to purchase health insurance across state lines, so they have access to more affordable plans; 2) transform Medicaid into Personal Health Accounts to allow more choices in health care and to reduce the burden to taxpayers; and 3) call upon Washington to address the problem it created when it required all hospitals to provide medical services to individuals with no way to pay.
 
These reforms will expand health insurance coverage for Tennesseans in a way that will not break the bank.
 
Medicaid expansion, on the other hand, would have been financially unsustainable in the long run. The program would have covered mostly male, able-bodied, childless adults making 138 percent of the federal poverty level or less. Only 16 percent of these individuals work full time, year-round. We should be focused on reducing unemployment for this population, not reducing the incentive to find work.
 
In the first two years, the plan would have added $1.4 billion per year to the federal debt and to Tennessee taxpayers' share of that debt. Medicaid is not like some federal plans in which a pot of money is allocated and then divided among states that participate. Medicaid money is only paid if enrollees receive actual services. Accordingly, every dollar saved by not expanding Medicaid in Tennessee is a dollar our grandchildren will not have to pay back to the Chinese.
 
Even assuming that the federal government chose never to lower its share of funding under Obamacare, in two years federal funding would have begun reducing to 90 percent. The remaining 10 percent may seem like a small share, but it would represent $200 million a year from Tennessee taxpayers. That is an amount four times the size of the 2 percent teacher pay raise scrapped from the budget last year.
 
Tennessee hospitals said they would pay all state costs, but U.S. Sens. Bob Corker and Lamar Alexander and President Obama had all proposed to take away the funding mechanism the hospitals hoped to rely on. Without funds, Tennessee would have been forced to kick able-bodied, childless adults off the rolls again, as former governor Phil Bredesen did in 2005.
 
Legally, Tennessee may not have been able to end the program even if it had wanted to. Bredesen's Medicaid lawyer recently wrote, "If the federal government wished, it could bind Tennessee to the mandatory Medicaid terms and thereby deny exit solely from Insure Tennessee."
 
In other words, like the Eagles' "Hotel California," you could check into Medicaid expansion, but you could never check out. 
Better to check into a different hotel.

Brian Kelsey
State Senator

* * *

I recently read State Senator Brian Kelsey’s 3 Point Plan for TN Healthcare reform. Yet once again a legislator has missed the major flaw in all healthcare reform including Medicare, Medicaid, the Affordable Care Act (aka Obamacare,) Insure Tennessee, etc.

The legislators in Nashville and Washington need to actually grow some attachments, and write the reform bills themselves (shudder.) Better still, allow a consortium of doctors, counselors, medical professionals with accounting backgrounds (think GOA types), etc. with no monetary ties to big pharma and for profit medi-systems with an emphasis on controlling skyrocketing medical costs, there will be no meaningful reform.

Please don’t start quoting left or right wing rhetoric about “death panels”, socialism, one-payer systems. The fact of the matter is that lobbyists currently write the majority of the legislation passed on the local, state, and national level and healthcare reform is no exception. Most legislatures are money trees for special interest groups and the laws concerning the medical care industry are no exception. Of course the only long term solution is to take the massive amounts of dollars spent on elections away and that would only be accomplished with a constitutional amendment banning paid political advertising, which sadly is a dream.

Folks, healthcare reform without meaningful cost controls is just rearranging deckchairs on the Titanic. The exponentially increasing national debt is the iceberg.

Robert Grier
South Pittsburg, TN

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