Health care reform in Tennessee 

​On the death of Healthcare Reform….
I just got off the phone from a phone call with the Tennessee Justice Center.   For many years,  along with the Tennessee Health Care Campaign,  they have been the leader in the fight for health care reform in Tennessee.   If there are experts,  at least in Tennessee,  they are it. 
They don’t “know”  any more than anyone else for sure what is going to happen for  sure but in conjunction with their national partners have some most likely guesses. 
They believe :
1.  The parts of the ACA that can be dealt with through budget reconciliation will be repealed by the end of January.   This would mean the tax subsidies and medicaid expansion in particular. 
2.  They think that legislation is already written and unless Trump insists on repeal and replace at the same time it is a done deal. 
3.  They believe the repeal will not be effective immediately but probably in two years. 
4.  There is no plan to replace right now.   That will have to be developed and implemented in the next two years or else the ACA will be repealed with nothing to take its place. 
5. They believe it is highly likely medicaid will be made a block grant to the states.   There will be no federal requirements to get the money.  States will decide who they want to insure and what kind of benefits they want to provide.  With an entitlement program federal participation increases as demand increases.   With a block grant once the state gets their money they get their money.   Historically block grants do not increase from year to year.   If anything they tend to decrease.   So if cost goes up in any way you basically must decrease benefits and in some way.   Their expectation as a rule of thumb is that less people will get less benefits. 
6.  They think if the Republicans try to keep the restriction that says no insurance company can deny someone for preexisting conditions they will find out that is not workable without the individual mandate and subsidies.   They are unclear where that will lead. 
7.  The coverage gap in Tennessee is very likely not going to be closed.   The ACA is the funding mechanism for expansion and it is unlikely to exist.   They think there may be an effort in Tennessee to try.   It has support from some legislators.  The deck is heavily attacked against it. 
8.  They think the Republicans will target Medicare and Social Security next year. 
This is my best recounting of what was said.   Others who heard the call may have a different interpretation of what was said but this is what I think will happen. 
It will be a profound restructuring of the medical system and the most profound consequences will be on the most vulnerable and those most likely to be hurt.   It will be more dangerous than ever  to be poor. 
If you are poor and sick or you advocate for those that are poor and sick it will be extremely hard time but the success of those who advocate against this insanity will mean the difference for too many Americans between life and death.

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