Two Democratic gubernatorial candidates vowed Tuesday to immediately expand Medicaid if elected governor, saying expansion was the key to filling Tennessee’s health care gap and saving rural hospitals throughout the state.
But the proposal was met with swift opposition from three Republican opponents, who insisted expansion was unaffordable and that the state’s next governor should instead negotiate block grants — which come with less funding but fewer strings — from the Trump Administration.
“We can argue and negotiate for more funds than we have now, hopefully as much as we would have gotten in expansion anyway,” said Republican Randy Boyd, pushing for block grants. “And the best part is, Tennesseans get to set the rules for Tennesseans, and I’m confident that if Tennesseans set our own rules we can do a better job.”
Tennessee governor’s race: See where the candidates stand on how to expand access to health insurance
In this way, the health care debate predictably hugged party lines at Tennessee’s latest gubernatorial candidate forum, which was held at Lipscomb University and hosted by Leadership Tennessee and the USA TODAY NETWORK – Tennessee and other organizations.
Five of the six top-tier candidates participated: Democrats Karl Dean and Craig Fitzhugh; and Republicans Boyd, Beth Harwell and Bill Lee.
U.S. Diane Black, a GOP gubernatorial candidate, did not participate.
Medicaid versus block grants
Medicaid, which is primarily funded by the federal government, provides health care for the poor and vulnerable populations like disabled people and pregnant women.
Some states have expanded Medicaid to cover residents who are not quite poor enough to qualify, but expansion requires an investment from state governments, which must spend money under federal guidelines.
Many Republicans support an alternative — block grants — which is federal funding for health care that gives states more authority over how the money is spent, but is capped annually by Congress, unlike Medicaid.
Poll: Health care a top issue for Tennesseans
This debate was pivotal to Tuesday’s forum, which began with both Democrats identifying health care as one of their top three priorities – as did Tennesseans surveyed by Vanderbilt University as part of a new poll.
Questions were also asked about hospital closures, opioids and the poor health of Tennessee residents, but Democrats always steered the conservation back to Medicaid.
Fitzhugh, a state representative, grew the most passionate about the topic, referring to Tennessee’s failure to expand Medicaid as the “biggest moral failure” of his 24-year career in the legislature.
“If we had expanded Medicaid, I am convinced those hospitals … would not have closed,” Fitzhugh said. “The first thing I would do, as governor, if I have to, is call a special session to have it done. It could re-open those hospitals. It will certainly keep more of those from closing.”
A moment later, Harwell said it was a “misconception” that Medicaid expansion would have kept the hospitals open, pointing to states like Kentucky and Arkansas, which still saw closures despite expansion.
Like Boyd and Lee, Harwell advocated for block grants, then warned that Tennessee had previously expanded TennCare, its version of Medicaid, then rolled it back in the mid-2000s because of the high cost.
“We have to be very very careful,” Harwell said. “I know it sounds good to cover everyone, but the bottom line is it consumes a huge part of our budget.”
Brett Kelman is the health care reporter for The Tennessean. He can be reached at 615-259-8287 or at firstname.lastname@example.org.
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