By refusing to expand Medicaid, as encouraged under the Affordable Care Act (ACA) program, “the state of Tennessee has essentially rejected over $10 billion in federal health care benefits for the most disadvantaged people of this state,” said Neil McBride, former Legal Aid in Oak Ridge director.
“That’s over $1 billion a year” of taxpayer money, he said.
McBride spoke at a recent online forum advocating expansion of Medicaid in Tennessee, one of 12 states that has rejected the federal funds.
McBride, former member of the Tennessee Valley Authority board and Tennessee Justice Center board of directors member, was one of four panelists who elaborated last week on the physical and mental suffering of, and financial costs to, more than 300,000 low-income, uninsured Tennesseans, including people of color, as well as up to 14 rural communities with closed hospitals as a result of the state’s rejection of Medicaid expansion funding.
In addition, “Tennessee has so far failed to accept $900 million in federal funds that would cover the cost of expansion for over six years,” said Judy Roitman, Tennessee Health Care Campaign executive director and moderator of the online panel discussion.
]The online forum speakers indicated that Tennessee holds the record for having the highest rate and number of hospital closures in the nation. As a result of unpaid medical bills, it has one of the nation’s highest number of personal bankruptcies.
Panelists commented on the limitations of TennCare, which is operating under a controversial block grant approved by the Trump administration. TennCare is the state’s Medicaid program that covers 21% of Tennessee adults and 50% of the state’s children. It provides healthcare to mostly low-income pregnant women, parents or caretakers of minor-age children, children, and individuals who are elderly or have a disability. One forum panelist said that in the past year, 200,000 additional people have qualified for TennCare.
The virtual forum was sponsored by the League of Women Voters of Oak Ridge, the League of Women Voters of Tennessee and the Tennessee Health Care Campaign. A second virtual forum featuring two legislators in the Tennessee General Assembly will be held on Tuesday, Nov. 16. Non-members of the League of Women Voters may access the second forum at this website: https://www.lwvtn.org/lwvtn_events.
More than 300,000 Tennesseans are in the healthcare coverage gap because they have an income a little too high for them to qualify for TennCare, but too low for them to be able to afford private insurance or get on the Affordable Care Act (ACA) health insurance exchange. Because these people have no health insurance, they often delay receiving needed healthcare.
Kathryn Crawford, a doctor of nursing practice and adjunct instructor in the University of Tennessee College of Nursing who works on health policy with the Tennessee Justice Center, said that as a critical care nurse, she has had uninsured patients who suffered “devastating effects” because they postponed critical care.
She noted that Tennessee exceeds the national average in its incidence of the top three chronic diseases: diabetes, high blood pressure and cardiovascular disease. The Journal of Health Affairs, she added, recently published a paper by a Harvard-Vanderbilt team titled, “Medicaid expansion slowed the rate of health decline for low-income adults in Southern states.”
Margaret Durgin, executive director of the Child Advocacy Center in Anderson County, gave an example of a low-income, uninsured woman who struggled to find enough money to pay rent, buy food and purchase gasoline for her car.
“She had a minor injury and infection she ignored because she couldn’t afford to run up an out-of-pocket medical bill so she postponed medical care,” Durgin said. “The infection spread throughout her body, and she died.”
According to the panelists, the estimated 300,000 low-income, uninsured Tennesseans are mostly essential workers who have been employed in the low-paying restaurant, food-service and construction industries. Some have lost income or their jobs because of injuries, illnesses — such as COVID-19 — or unforeseen layoffs. Some have quit their jobs to give full-time care to children or an ailing family member.
Alisa LaPolt, policy and advocacy director of the National Alliance for Mental Illness in Tennessee, said that Medicaid is the largest payer of mental health and substance abuse services in the country. She estimated that at least 60,000 low-income, uninsured Tennesseans who don’t qualify for TennCare suffer from mental health illnesses, including those with manic depression and schizophrenia.
“If mentally ill people wait too long to get mental health services, it will be more difficult to guide them into a happy, productive life,” she said. “Their illness might manifest as behavioral problems, which could lead them to the criminal justice system. We would rather give them help, not handcuffs.
“Other mentally ill persons may commit suicide. We are already seeing record drug overdose deaths in this state, so the lack of good health insurance is taking lives,” she said.
LaPolt said that being low income is a risk factor for mental illness.
“Anxiety and depression are the leading causes of worker disability,” she added. “If employees have these mental illnesses in the workplace, they can’t work and have to quit their jobs. Then they have to apply for TennCare, which often they can’t get.”
In Tennessee 14 hospitals have closed and another 20 are at risk of closing in the next three years, McBride said. Tennessee hospitals can’t stay open “without a financially viable base of patients,” referring to low-income, uninsured residents of communities who need hospital care but refrain from getting it for financial reasons until they must go to the emergency room.
McBride noted that rural communities suffer from a hospital closure because they lose high-income medical professionals who bring leadership and financial support to churches and nonprofit service organizations, and patronize local businesses. These communities are also less likely to attract new businesses that create jobs.
“These closures are directly correlated to the decision by the state of Tennessee to not accept Medicaid expansion,” he said. “Some 72% of all hospital closings in the country are in states that rejected Medicaid expansion.”
Under the American Rescue Plan Act of 2021, states that adopt Medicaid expansion have to pay only 5%, not 10%, of the cost, with the rest being federally funded. When this law was passed, McBride said, “Tennessee hospitals jointly pledged as a group to pay the state’s contribution to Medicaid expansion because it’s so clearly in their financial interest to do so. There would then be no cost to the state to join the Medicaid program.”
The pledge has expired, but it is widely believed the hospitals’ promise will be renewed, he added.
The forum panelists offered three reasons why the Republican-led Tennessee General Assembly has rejected Medicaid expansion since 2014. State legislators are afraid that the federal government might pull out of the deal and leave the states responsible for funding most of the Medicaid insurance for a larger population. They are fundamentally opposed to the former president whose administration enabled Medicaid expansion. They see the additional funding as an entitlement for unfortunate folks they view, or stigmatize, as lazy and unwilling to work.
“The U.S. Census estimates that over 836,000 Tennesseans are without any health insurance coverage, or about 10% of the state’s population,” Crawford said. “We know that all people need health care; it’s a fundamental human need.”
LaPolt said, “The Declaration of Independence declares that ‘all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness.’ How can people pursue life and happiness if they are ill and their healthcare is declining? I think health care is a fundamental right and we should remind our legislators about our rights.”
If you wish to express your support or opposition to Medicaid expansion in Tennessee, contact your state legislator. Names, addresses, phone numbers and email addresses can be found at the Tennessee General Assembly website.