I went to the Tennessee Health Care Campaign annual meeting in Nashville today. A full day of some of the people who have made a difference in Tennessee everyone from legislators to people who had been on the front lines of the battle for health care justice in Tennessee for years. I heard where we have come from, where we are and where we can be. The battle ahead is uncertain. There are many obstacles ahead. While I heard no one talk about a wishful optimism I heard many people talk about the hope that a battle for health care justice of many years, a battle with way too many casualties and way too many deaths had a chance, a real chance to finally bear final fruit. I heard about battles ahead but maybe, just maybe, an end to a war.
After listening all day and trying to piece together some many thoughts and observations from so many here is my sense of things.
We have been told that Insure Tennessee, Governor Haslam’s plan to expand insurance coverage, is dead. Normally a lot of reasons are given, particularly by those who are trying to find justification for their inaction, to explain why. How a plan that would cost the state nothing, provide insurance to 280,000 people unnecessarily suffering and even dying, save our rural hospitals, boost our economy with thousands of jobs and other benefits, bring Tennessee tax dollars back to Tennessee could be portrayed as so lacking in value it doesn’t even deserve a vote in our legislature probably needs lots and lots of reasons.
Justification is not explanation though and lies no matter how often and enthusiastically told do not make truth.
If a foreign power did something to cause as much damage to the people of the state of Tennessee as this has done it would be judged the foulest act of terrorism. Our damage is self inflicted but the shame is no less and the injury no less far reaching.
The truth is this and it is so much time to bluntly say it. The reason that Insure Tennessee is not law in the state of Tennessee is twofold.
1. Some people hate Barrack Obama so bad they are willing to do anything they can they think will hurt or injure him regardless of the costs and consequences to the people they supposedly serve.
2. Some people are so afraid of making the people who hate Barack Obama mad because of what they fear would be the political consequences of that anger they are willing to stand and do nothing.
Rather it is because Obama has an inconvenient skin color or whatever the real reason is irrelevant. Insure Tennessee was a victim of political expediency. At one point I entertained it as a possibility but I now believe there is not any evidence that Insure Tennessee failed because of a defiency of education, of rational argument or advocacy. Insure Tennessee was simply a victim of a volcano sized helping of hate, fear and political ambition.
The opponents of health care expansion have tried to cover things up in a blizzard of lies and misstatements. But the facts are in and clear. The only real question is what impact those facts will have.
A recent article quoted a study published in Jama (Journal of the American Medical Association)) examines the difference for people in Kentucky and Arkansas which did expand Medicaid and Texas which did not :
Two years after Medicaid coverage was expanded under theAffordable Care Act (ACA) in their states, low-income adults in Kentucky and Arkansas received more primary and preventive care, made fewer emergency departments visits, and reported higher quality care and improved health compared with low-income adults in Texas, which did not expand Medicaid, according to a new study led by researchers at Harvard T.H. Chan School of Public Health. The findings provide new evidence for states that are debating whether to expand or how to expand coverage to low-income adults.
The article adds:
Expansion also was associated with significantly increased access to primary care, improved affordability of medications, reduced out-of-pocket spending, reduced likelihood of emergency department visits, and increased outpatient visits. Screening for diabetes, glucose testing among people with diabetes, and regular care for chronic conditions all increased significantly after expansion. Quality of care ratings improved significantly, as did the number of adults reporting excellent health.
It works if we work it. Will we work it?
There is a new plan. The Speaker’s Task Force has unveiled what they call “The 3 Star Healthy Plan.” There are real differences between it and Insure Tennessee. It is a two phase plan. It would bring into coverage first those with mental health conditions in its first phase and if that works everyone else in a second phase. If passed it would basically do in two years what we could have done two years ago.
The most important thing about it is that it has to some degree a real chance of passing. At least it should make it to the floor.
There are still real questions and real obstacles. There is still negotiations going on with CMS and the final form of the plan is far from set. Obviously chances of passage are affected by what the final form of the plan takes. But regardless of that form there will be some real challenges that have to be dealt with.
These are what I think are some of the changes, the obstacles, the questions ahead. Others may disagree but this is my take:
1. What effect, if any, is the presidential election going to have on the legislative session ahead? No one knows the answer to that. It may have none. But opponents of Insure Tennessee made that a contest about Barack Obama and if the election goes as it appears it might then will organizations like Americans for Prosperity attempt to make the 3 Star Plan a referendum on Hillary Clinton? Whether or not that happens and how it is responded to will be crucial. State legislators have shown consistently how responsive they are to threats “the tea party is gonna get you.”
2. How easily does this proposal make it through the House and how does it deal with the objections that are brought up to it? This will define the momentum going into the Senate which will be crucial. It will need to justify taking the 35% match instead of the 90% match that Insure Tennessee would have got as a good idea and indicative of conservative values. It will need to justify the two phase approach as giving the state something of a safety valve if things do not go as planned. After two years of uninterrupted propaganda about how any expansion is a bad idea that will destroy the state those who support the plan must pivot and explain why expansion is essential and the right thing to do (In the ironies of ironies they must convince colleagues that many of the arguments for Insure Tennessee for the rationale of expansion were correct.). They must explain the nuts and bolts of the mental health expansion in phase 1 in such a way as to dispel any doubts and questions. They must convince people of the wisdom and necessity of voting yes on phase 1 and phase 2 at the same time and not coming back for a separate vote on phase 2 after phase 1 is complete. All of these are questions the Senate is likely to bring up and how the House deals with them is essential.
3. Bill Haslam. Will he be the Governor on this issue. He abdicated his job on Insure Tennessee. When the going got tough he left. This proposal might pass with an absentee Governor but Insure Tennessee did not have a chance without him and I am not convinced this will not make it over the final hump without him.
4. The Senate. They will have a new lieutenant Governor this term and it looks like it will be Senator Randy McNally. He has been an intransigent foe to any kind of expansion for many years and he will have the ability to make the passage of this plan much more difficult if he chooses to. He will probably be eager to show that he is in charge and will resist any appearance that even suggests he is junior to Beth Harwell. He doesn’t need to come out in favor of the plan but he probably does need to say he is in favor of the full Senate being able to make the decision. He cannot stack committees like his predecessor did to make sure the bill does not get to the Senate floor. Everything I have heard says at this point the votes in the Senate are not there for this bill yet and what Randy McNally does will make a difference.
5. Us. What we do makes a difference. That was shown this past session. Without the direct actions taken by the people who were not willing to simply let things die, by the movement for Insure Tennessee there never would have been a Task Force or a Three Star plan. Efforts need to be made to educate and encourage legislators to support and pass this new plan. That voice needs to be loud and passionate. But this is my view and perhaps I am in the minority here. We can never again accept a bad faith effort by the legislature as being something that we can or should do nothing about. Direct action made a difference this past year. My hope is that things have genuinely changed and that the effort for expansion is real and impactful. But past experience tells me that the legislature, particularly if it is perceived as being contrary to the defined interests of the Republican party, has never been particularly open to rational discussion and even acknowledging the facts on this issue. We cannot, if we are truly standing up for the 280,000, accept political expediency as an answer we are willing to accept. And if this legislature, like the two before it, act in bad faith I hope that we will act. At minimum if it is not comfortable to expand care to those without coverage we should make sure it is uncomfortable not to act.
For what it is worth that is my take. I don’t know how widely shared my feelings are and would like to hear from others.
There was a lot talked about in Nashville. I learned a lot and got to meet many people worth meeting.
I hope this is the year the Gap closes. Too many people can’t wait much longer. They just can’t.
In 4 days my 8 years in the gap will be up. Medicare will kick in. I will be able to go to the doctor. God how I wish everyone could.