One in 12 Tennesseans are insured through the Affordable Care Act, which offers reduced-cost private insurance plans. That’s 555,000 Tennesseans who don’t qualify for TennCare or Medicare, aren’t insured through their work, and can’t afford traditional insurance.
On the campaign trail a few weeks ago, House Speaker Mike Johnson said that if Donald Trump won a second term and Republicans kept the House, there would be “no Obamacare.” That’s the ACA.
Trump ran for president in 2016 promising to repeal the ACA, which at that point covered 13 million Americans. He had no plan to replace it. He wasn’t focused on the ends. He didn’t like the means: another federal safety net program, nicknamed after a man he dislikes.
Trump tried to repeal the ACA, but stripping people of their health insurance turned out to be politically unpopular. Now, apparently, the ACA is back in the crosshairs.
Even if the ACA survives Trump’s second term, a 2022 subsidy to the ACA probably won’t. The subsidy has made premiums more affordable and boosted enrollment to more than 21 million. If Congress lets the subsidy expire next year rather than renewing it, premiums are projected to rise by an average of 79 percent, and the number of Tennesseans without health insurance is projected to rise by 39 percent.
I suspect Congress will ignore the ends and focus only on the means: it’s Biden’s subsidy, and it uses federal dollars. If they eliminate it, mission accomplished.
But is that good governance?
Recently I was discussing health insurance with a woman who does medical coding here in Chattanooga. She told me she regularly sees cases where uninsured diabetics have amputations that could have been prevented with proper disease management. They can’t afford to go to the doctor, so they put off going until they’re miserable. Then it’s too late.
Tennessee already has high rates of diabetes and other chronic diseases. That’s about to get worse. It also has sky-high rates of household medical debt and bankruptcy. Those are about to get worse too.
Many of us have seen or felt the ripple effects of medical debt. I watched it bankrupt a family I care about. They lost their small business, their house, and their credit. They never recovered.
Even if we aren’t affected personally, we all lose when many Tennesseans can’t afford to go to the doctor or pay their medical bills. That’s how we get overcrowded ERs and shuttered county hospitals and higher insurance rates.
Governor Bill Haslam understood the economic reasons for getting more Tennesseans insured. He tried to get our state legislature to accept the federal funds to expand Medicaid (TennCare). They wouldn’t do it then and they still won’t, apparently for ideological reasons.
Forty state governments now accept those annual Medicaid funds, but Tennessee has deliberately left more than $22 billion—our own federal tax dollars—on the table.
I’ve never seen elected officials so dedicated to denying us access to health care, and so disinterested in giving us what we paid for. (With public servants like these, who needs insurance adjusters?) While they’re running interference between us and the health insurance that we’ve paid for with our taxes, they’re receiving health insurance that we paid for with our taxes. I guess their ideology doesn’t extend to themselves.
I’m reminded of another conversation I had, this one with a woman who studies public health systems across the country.
She told me that the Cherokee Nation in northeastern Oklahoma is building a network of health centers so nobody in that fourteen-county area has to drive more than thirty minutes to get to the doctor. The tribal government is cobbling together funding from Indian Health Services, Medicare, Medicaid, and private insurance, and covering the last dollar itself. It’s partnered with various providers, as well as the VA, to give every resident access to pharmacy and optometry services, diabetes education, behavioral health services, veteran services, and medical specialists.
Imagine elected officials who won’t play politics with health care, who’ll give us a full return on our tax dollars, and who are focused only on using those tax dollars to improve our lives.
That’s a model of good governance. Let’s scale it up.
Allison Gorman
* * *
Is it good governance to tell people for decades Republicans would sell TVA? That tune fizzled out about 25 years ago. Is it good governance to tell people for decades Republicans would cut Social Security? That aria started going sour about 15 years ago. So what symphony are Democrats playing now? Republicans will end ACA.
It may surprise them but there’s nothing affordable about their care. Four years of Bidenomics gave us high prices that won’t go away and prices could rise again in the next few months before President Trump’s policies can start moderating them.
Joe Biden was out there yesterday taking a virtual victory lap over his so-called greatest economy in the world. Why did he do that? His party wants you to believe if there is a short term rise in inflation they can claim Trump’s a failure. It’s all a hoax like so much of their administration these last four years.
Is it good governance to keep running hoaxes? That’s why 77 million American citizens rejected their form of governance in November.
Ralph Miller
* * *
I believe Ms. Gorman’s letter is very accurate. She offers much, much more than just a grain of truth.
For many Republicans, “good governance” means the rejection of federal Medicaid dollars.
”Good governance” also means repealing the ACA. Republicans would leave the 21+ million citizens enrolled in the ACA with nothing, as of January 2024. Adding family members and an unknown number who are not insured but for whom the ACA is available, the total affected will be much, much more than 21+ million citizens.
How is the rejection of Medicaid dollars by a state and repeal of the ACA “good governance”?
Presumably, it’s only the money, an estimated $125 billion in ACA subsidies in 2024 (House Ways and Means), and $860 Billion in F/Y 2023. Yes, a rather large amount of change worthy of detailed examination, but not knee-jerk Republican politics of repeal, as it appears to me.
I’ll add that for Republicans, a hatred of anything Obama is also considered “good governance”.
The only response to Ms. Gorman was by Mr. Ralph Miller.
But rather than offering his opinion on Republican “good governance” with examples, Mr. Miller appears to be offended that Ms. Gorman even references Republicans. Her letter allows Mr. Miller to further harangue about President Biden, who will be out of office in about five weeks, as well Mr. Miller’s perception of Democratic fallibilities.
Mr. Miller defended Republican “good governance” by using what is presumably Democratic campaign rhetoric. That is no defense.
Mr. Miller is also incorrect by implying that Republicans would never sell the TVA (what would we do without this magnificent Democratic project?), would not cut Social Security (another revered Democratic institution) or would not repeal the ACA. Apparently Trump, Musk, and Ramaswamy believe all government costs and programs are fair game for cutting or eliminating. So the TVA could be sold.
As for the ACA, Republicans went to great effort during Trump’s first term to repeal the ACA. That failed. Trump had told the public that he had a far better plan, but produced nothing as a replacement. Today, many MAGAs (i.e. Speaker Johnson, et.al) are practically guaranteeing the ACA will be repealed. For replacement, Trump offers only a “concept of a plan” (stored in his mind?) and, again, no details of a plan. “Fool me once, shame on you. Fool me twice, shame on me.”
Republican threats to cut Social Security and repeal the ACA are not hoaxes, as Mr. Miller alleges.
Mr. Miller closed by summarizing that 77+ million voters rejected Democrats. He glaringly omitted that total was 49.9 percent of all votes. Not a majority; only a plurality.
Yes, Ms. Harris received fewer votes; her total was 74.7 million votes.
But the universe of voters must total 100 percent. Simple subtraction clearly shows 50.1 percent of all voters rejected Donald Trump - again.
That, Mr. Miller, is the true majority. That is no mandate.
Joe Warren