An autopsy of Insure Tennessee

Insure Tennessee is dead.  

If she didn’t kill it, with her announced task force in search of “conservative Tennessee principles” Speaker Harwell at least buried it. She even got Governor Haslam to mutter an epitaph.


How can something that makes so much sense, that offers so much to do many, and so much to Tennessee fail so utterly, so badly after so much effort by literally thousands of people? How can something supported by the vast majority of Tennesseans not even get a hearing or vote in the legislature that supposedly represent them.

The most popular explanation is fear. Legislators are afraid of primary challenges if they come out in favor of Insure Tennessee. Basically the Tea Party will get them. Related to this is the idea they will face retribution from legislative leaders not in favor of Insure if they speak out.

The main advocacy tactic was to urge people to get past their fear. Leaders were urged to give their members coverage for stepping up in favor of Insure. None did and for the most part no one ever really stepped out publicly. The goal was to make it easier for them to get past the fear, to make the support of Insure not as much of a felt danger. We made sure everyone had the facts to justify their decision and the stories to highlight the moral urgency of that decision.

In the end, without some type of leadership supporting it, it was a decision not many were willing to make.

I have no doubt this was the true circumstances for some members. They wanted to do something. It never seemed like it had much of a chance and they just didn’t see it as worth the risk.

But at best it is only part of the explanation.

Last year a Representative told me there was only two kind of people in the legislature : those against Insure Tennessee and those afraid of those against Insure Tennessee.

Right from the start it was met by violent antipathy. It was written off as Obamacare and while most outside the legislature seemed to realize it was more than that in the legislature it remained the central claim of those that opposed it.

The key to understanding this is in that term that Speaker Harwell throws around a lot…. “conservative Tennessee principles.” Many of them do not like Tenn Care because of its size. They do not like the idea of the government doing so much for so many and if it not for federal requirements they, I believe, would have taken surgery to Tenn Care long ago. Insure Tennessee was just one more thing doing a lot for a lot. If you listened to Ron Ramsey talk about block grants and you listen to what many other legislators have said it is clear I think. They want a program that does less for less people and if the federal government insists they do more they would rather blame the federal government and refuse any money.

A task force to find a plan based on “conservative Tennessee principles” is a way to find way to come up with a plan that does less for less, justify it as financial responsibility and wash their hands of it and blame the federal government if they don’t win the permission to do so.

Even at the start the task force is talking about pilot programs etc. I believe it is clear based on the
whole context of what has been said over the last two years that their goal is not to find a better way to serve 280,000 people but to find a better way not to serve the 280,000. The death of Insure Tennessee is a direct result of “conservative Tennessee principles.” It has something to do with groups like Americans for Prosperity but more than anything else it is simply a reflection of the people we have chosen to represent us.

So what does all this mean for what happens next?

1. In the long run the coming election is of utmost importance. This is true for two reasons. There is a ceiling to how much progress will be made with the current legislators. We need to change some numbers. The second reason is equally important. Legislators need to know there is a consequence for being against the welfare of 280,000 “of their fellow Tennesseans. Up until there had really been no consequences.

2. In the short run I agree with many things I have heard from other people. Haslam is irrelevant at this point. The Senate will do nothing. With this task force the House has assumed all the risks and I think both Haslam and the Senate are more than content to let them do this.

3. Anything that happens will as others have said originate in the House.

4. Based on the composition of the task force, the way it was presented, and the immense pressure the speaker has been under the most likely conclusion I think is that the fix is in with the task force. The question needs to be asked often and forcefully. Are you talking about the 280,000
or not. Anything less than that must be clearly defined in the most intense terms as illegitimate.

5. There should be clear and strong effort to broaden the makeup of the task force as well as its agenda. They need to feel the pressure to prove they are not simply an ideological cover-up charged with getting the speaker and her allies off the hot seat.

6. The 280,000 need to be the clear and unwavering focus of everything and anything that doesn’t do that must be challenged as strongly as we can with the resources at our disposal.

7. Personally I think if possible there needs to be some kind of direct action at the legislature before the end of the session. The message of the action should be simple and direct : “Speaker Harwell you have ignored the feelings, the wishes and values of the majority of Tennesseans by your refusal to support or even give a real hearing to Insure Tennessee. You have put 280,000 Tennesseans at risk. There is no plan, no option no where for them to turn. In saying you want to devise a better plan, an option to Insure Tennessee, you have, in our view accepted the responsibility for the 280,000 in need. It is a responsibility we will hold you to. So part of that responsibility we expect a plan that covers all 280,000 people, that stabilizes a decaying rural health infrastructure, and that creates jobs for Tennesseans. We hope for a plan that at least equals the benefits promised by Insure Tennessee such as not putting a financial burden on the citizens of this state and putting Tennesseans taxes back to work for Tennessee. It is, in our view, a matter of considerable moral urgency that this crisis be dealt with fairly and honestly and openly. The assumption of responsibility is a heavy responsibility. We pray that you are up to it. ”

8. If the fix is in and we are unable to change that then health care reform may be dead. And the hardest question is what then? How non negotiable are our expectations and how far are we willing to go to defend them. It is a question I hope we never get to.


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