Health Care Will Be Back As A Hot Campaign Issue

There is no shortage of people who have repeated Winston's Churchill's observation that one should never let a crisis go to waste. That notion can often be rightly written off as a cynical move to consolidate power, but it contains more than a grain of wisdom. The COVID-19 challenge provides the opportunity to prune away extraneous ideological baggage and solve real problems.

Though the COVID-19 pandemic and now elections are the dominant issues of the day, health care policy is lurking. Remember the Obamacare obsession of four years ago and "Medicare for All" from the primaries? It will be a major campaign issue this fall. And it should be back on the agenda in Tennessee.

Medicare and Medicaid

Health care has been a constant national and state policy challenge for the last century. Medicare was a giant decades-long battle before Congress finally approved it in 1965 -- when the words "socialized medicine" brought about fear and loathing. Medicaid, the program to provide medical coverage for low-income people, came about at the same time.

The states have long had responsibility under Medicaid to deliver care under federal guidelines with the feds footing most of the bill. One loses eligibility with increasing income. This brings about an unfortunate situation for many working poor without private health insurance, who greatly benefit from the Affordable Care Act, aka Obamacare.

TennCare and Insure Tennessee

Not so long ago Tennessee was a leader in what some might now call the "Medicaid space." In 1994 Gov. Ned McWherter negotiated with the federal government for a waiver from Medicaid. The idea was to take the same federal funds coming in for Medicaid and have Tennessee deliver health care through a managed care program called TennCare.

TennCare was a novel and creative approach, introducing a primary care physician and hopefully regular checkups to catch and treat situations earlier. A major goal of the program was to reduce a crippling reality of our health care system -- treatment provided, often too late, in the worst place for patients and the most expensive place for those footing the bill: the emergency room.

State leaders expanded coverage and were optimistic about the program and its future. But eventually, costs exceeded projections and ate up more and more of the state's resources. Gov. Phil Bredesen, like McWherter, a Democrat, was forced to remove many who had recently been added. In making these cuts, he raised the ire of many Democrats and brought lawsuits from public advocates. While there were many lessons to be drawn from the TennCare experience, Republican leaders have long drawn on one: if you expand coverage, you will have a very difficult time ever scaling it back.

This logic helped overwhelm Gov. Bill Haslam's later attempt to expand Medicaid through Insure Tennessee, a responsible and creative attempt to take advantage of available federal funds and cover more Tennesseans. Most Democrats, but only a few Republicans, supported it in the General Assembly, where it was dead on arrival.

Tennessee Republicans' objections to Medicare expansion are not unfounded. If we take federal money now and expand coverage, we may find it impossible to cut coverage if the federal money goes away. That thinking served as a fig leaf for the real reason for many who would in no way acknowledge or accept Obamacare. Voters in Oklahoma and Missouri, both with Republican legislatures, approved Medicaid expansion through statewide referenda. Tennessee does not have such statewide votes for other than constitutional changes. So the burden falls to elected officials.

It is time to rethink, rebrand and resurrect a version of Insure Tennessee or otherwise expand Medicaid and address the very real needs, not only of Tennessee's uninsured but also of financially distressed hospitals that serve so many.

William Lyons worked as a professor of political science at the University of Tennessee and served in policy-related roles for Knoxville Mayors Bill Haslam, Daniel Brown, Madeline Rogero and Indya Kincannon.

William Lyons

Columnist