On closing the coverage gap : a followup to the Thcc meeting


My previous post (see link above if you have not read it) was my analysis of where we stood in the fight to once and for all close the coverage gap. This post is a followup to that and talks about some possible action steps to address possible obstacles to success.

In the last post post I identified what I thought might be the 5 major challenges to success.

1. Define the problem. Insure Tennessee died because we did not define the problem in a way that legislators bought into. Americans for Prosperity defined it as a referendum on Barack Obama and the game was decided before the first pitch was thrown. If we allow others to define the issue again we will lose again.

In the preceding post I talked about my fear that the attempt will be made to define this as a referendum on Hillary Clinton and I still fear that might happen but my concerns go even further than that.

A. The issue needs to be defined as a Tennessee problem and not about national issues. It needs to be about us doing the right thing for people in Tennessee. Any attempt to define it as being about national politics needs to be redirected in the most concrete terms to Tennessee. It needs to be about making Tennessee better for Tennesseans.
B. At the same time I think we can make use of data suggesting states like Kentucky and Arkansas have been successful in making a difference with people in their states. The message needs to be their solution may not be our solution but doing something matters. One of the biggest myths about Insure Tennessee was the idea that whether or not we did anything or not it wouldn’t matter. We need to loudly and concretely say to everyone it does matter. This needs to be about making a change that really changes things.
C. We have to define the context of the argument. Legislator after Legislator has said that big mistakes were made in the way the case was made for Insure Tennessee. The phrase I have heard so many times is “people in thousand dollar suits asking for more money.” One Legislator said it very bluntly to me, “If you are going to ask us to help people you need to do a much better job of putting the people who need help in front of us.” One thing that I would strongly suggest is we need to make sure that every Legislator has met at least one person in the gap that lives in his district (hopefully more than one.). We would be well served to the maximum extent possible that when a Legislator heard the term coverage gap it reminded him of the life of a real person. We need to personalize the issue.
D. We need to own the values that matter. Not closing the gap has not been financially responsible. It has, in fact, been reckless. Again every Legislator needs to have some concrete idea of how not closing the gap has economically impacted his district and some idea of how closing the gap could address that impact. Pro life needs to be about pro living. Responsibility does not stop at birth and we need to make that a strong point. Making our people healthier is pro family and pro community. It is about us being for us and maybe that needs to be the overall message. Closing the coverage gap is about us being for us.

2. The House. It is essential this proposal do well in the House. It will probably not be as easily accepted in the Senate and the momentum coming from the House will make a difference. I would suggest that key selling points be identified now and some kind of consensus be reached about how to message them.

A. The rationale for a 2 phase proposal needs to clearly be shared with everyone. One of the problems with Insure Tennessee is that it scared people. People had flashbacks to Phil Bredesen and no one wanted to go through that experience again. Too many people too fast was a losing proposition. Legislators need to hear the idea of building on success.
B. The rationale for choosing to start with the mental health population needs to be vividly made. Most families and every community has been impacted by the issue of mental illness. Sheriffs in every community need to be approached and those sheriffs encouraged to share with their legislator. Every advocate needs to know how mental illness has impacted their community and be able to give to Legislators some idea of how this might make an impact.
C. The mental health community needs to be on board with this and be prepared to testify in what ever kind of hearings are held. If it can be framed that being for this proposal is being for mental health it will be more difficult for Legislators to say no.
D. Their needs to be a clear rationale for how taking the 65% match instead of the 90% match can and will work for the state of Tennessee.
E. Many legislators represent rural districts. The case needs to be made as vividly as possible that without expansion we are moving towards two different health care systems : one for rural Tennessee and one for urban Tennessee. As much as possible each rural legislator should be educated as to how this affects their specific district.
F. In every hearing held the voices of people in the gap need to be heard and present. We do not need a steady stream of “thousand dollar suits.”

3. The Governor. I don’t know exactly what to say here. I think him being strongly in favor of it might make a tremendous difference. He can certainly give legislators a lot of cover and Speaker Harwell a lot of coverage if he will. Credibility is an issue here. He cut and ran when the going got tough on Insure Tennessee. When he gave the message that he would not fight for it it destroyed any chance that anyone else would put themselves at risk and fight for it also. If he is willing to fight for it, to use whatever capital he has to advance and defend it then he can play an essential role. If he is going to repeat his Insure Tennessee performance then we would be better served by him setting it out.

4. The Senate. I think this might be the biggest obstacle. The votes are not there right now and getting them may be difficult. Randy McNally will probably be the lieutenant governor and he has long been against any kind of expansion. His first time out of the box he is going to want to show he is in charge. By the same token I think he may not want to take on the burden of being the bad guy on his own. He will not want to look like a failure. He does not need to support the plan. He just needs to not kill it. Personally I think his response might depend on how well the first three items on this list goes. If the plan stumbles into the Senate I fear how well it will do. If it comes to the Senate strongly and with consensus behind it the question then becomes to what degree is he likely to stick his neck out to kill something so many are so strongly in favor of. I think he can probably kill it if he wants to. We need to make it worth his while not to.

5. Us. We can be the deciding factor. I think the only reason there is an option right now is that we helped Speaker Harwell to decide it was in her best interest to provide one. Strategy may need to be decided based on how things are going. This post has lots of concrete suggestions for things that can be done. I want to end with a word about direct action. I think direct action is what tipped the scales and got us to where we are today. I think some people are uncomfortable with the idea and very wary about how much of it we do and how far to push the envelope. I think the deciding factor is good faith. At the point in time when people no longer work with you in good faith (and I think everyone realizes that the previous legislature did not act in good faith) then the question of direct action needs to be addressed. If they are not going to say yes we need to make it as uncomfortable as possible to say no. That is my own personal opinion. I think 280,000 people are counting on us and the legislature needs to know it is not if we win but when we win.

These have been my thoughts about where we are and what might be helpful to do. I appreciate you considering them. If you think they are worthwhile I hope you will share this post with as many people possible.

For me this has been a long time journey as it has been for many of you. Too many people have had to wait for too long. Too many have ran out of wait. Nobody needs to wait any longer.

It is time. Long since time. Close the coverage gap.

Leave no one behind.

Let’s make this the last go around.


Larry Drain


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