By William Lyons
We didn't need the COVID-19 pandemic to tell us: If government's first charge is keeping us safe, a big part of that is the role it plays in keeping us well.
Health care has loomed large on the national agenda for decades. The battle of the 1960s was about Medicare. The Clintons couldn't enact reforms they campaigned on. Who can forget John McCain's thumbs-down vote to save the Affordable Care Act? Or last year's topic, Medicare for All?
Well, it's back again in a big way. The main legislative architect of the ACA, also known as Obamacare, is now president. Among Joe Biden's top priorities is rejuvenating this program after its kneecapping under the Trump administration.
Tennessee has a special relationship with the federal government regarding health care. TennCare was innovative, negotiated under a Democratic governor and a Democratic president. It stressed managed care and prevention.
Tennessee remains one of 12 states not to have expanded Medicaid to cover around 300,000 additional Tennesseans. In 2015 then-Gov. Bill Haslam tried with Insure Tennessee, a variant with more patient responsibility. Only a few Republicans were in favor of it, and it died a quick, if not painless, death.
One of the Trump administration's last acts was approving Tennessee's application for a block grant waiver for the operation of Medicaid. Tennessee was the only state to apply for and to be awarded such a waiver. Tennessee also wants to join some other states and tie Medicaid benefits to a work requirement. Such requirements have been difficult to implement in other states.
Both may be on the federal chopping block. The block grant has become a matter of great dispute. It fits well with the philosophy of Gov. Bill Lee and most of the Republicans in the legislature, providing Tennessee officials flexibility to deliver services efficiently and share the savings with Washington.
The waiver goes very much against the grain for Democrats, who regard the Republicans' efficiency argument as a cover for providing fewer benefits to many who need them. They point to funds left unspent in the Temporary Assistance for Needy Families program and have implored the Biden administration to hold Tennessee to more normal status under Medicaid, complying with federal rules for eligibility and benefits.
The health care 2021 extravaganza is further complicated by another proposal by Republicans Ron Travis in the House and Richard Briggs in the Senate to resurrect the essence of Insure Tennessee, with expanded Medicaid coverage. And national Democrats have put even more money in drafts of their COVID-19 relief package for states that opt for Medicaid expansion.
So what's next? The action's on two fronts. The fractured response to the pandemic underscored the need for federal prominence in health care. In the short run, we're going to continue with a rejuvenated Affordable Care Act because there is no viable alternative. Medicare for All might have provided some kind of bridge, but the lack of details doomed it during the Democratic primary period.
Federal funding increases notwithstanding, Lee and leaders of the General Assembly cite the possibility of future costs to state taxpayers in opposing expanded Medicaid coverage. Meanwhile, the recently granted waiver likely won't survive under Biden, although it may take a while to unwind.
Every discussion of who is and who is not insured, through whatever means, must recognize one very uncomfortable but unavoidable truth: Leaving people uncovered has a great human and financial cost.
Something has to change.
And it will ... eventually. In the meantime, more people should be brought under Medicaid, the sooner the better.
William Lyons worked as a professor of political science at the University of Tennessee and served for more than 16 years in a number of policy-related roles for Knoxville Mayors Bill Haslam, Daniel Brown, Madeline Rogero and Indya Kincannon.
Knoxville News Sentinel
USA TODAY NETWORK - TENN.