Some who support the program’s expansion reside in largely rural areas like Northeast Tennessee. According to Tennessee State University student and Protect My Care organizer Jacob Huss, these residents face unique challenges when it comes to health care access.

“Rural residents often have to travel long distances for a doctor’s visit and have fewer options when choosing a health care provider. Rural communities also face economic challenges and that can make it much more difficult for residents just to frankly afford their health care,” Huss said. “Many can’t rely on employer-based coverage because it isn’t always offered, especially in a field like agriculture, which so many people rely on directly or indirectly in rural areas.”

While there is a need for health care among many rural Tennesseans, Huss said many state Republicans’ refusal to expand the program has much to do with their opposition to the Affordable Care Act.

“Since they aren’t able to repeal it, they are sabotaging it,” Huss said.

“Refusing to expand Medicaid is another attack on our health care because many Tennesseans rely on Medicaid,” he continued. “A majority of us support the expansion of Medicaid — 63 percent of us want to expand it — but the Republican elected officials still refuse and ignore the needs and wants of their constituents.”

State Sen. Rusty Crowe, R-Johnson City, said he believes Tennessee needs to find its own approach to providing affordable health care, but said he doesn’t view the ACA as an appropriate model, because “it is falling apart quickly and has become unaffordable for most everyone.”

“I did vote for Gov. (Bill) Haslam’s Insure Tennessee (in 2016) as it was a plan that required personal responsibility of the patient and was a market-based approach. It would have helped those that fell between the cracks and couldn’t qualify any other way. We passed that through the Senate Health and Welfare Committee but it failed in Senate Commerce,” Crowe wrote in an emailed statement to the Johnson City Press. “I think if we were to be able to receive a block grant from the federal government so that we could use the dollars as we see fit and put in place our own Tennessee-oriented approach like the TennCare program we currently utilize that has saved billions of dollars throughout the years, we might be able to make progress.”

On Thursday, Sandy Rice, a nurse practitioner in Sewanee and Molly Mann, a Viola resident enrolled in the ACA marketplace, joined in a press conference call hosted by Huss to discuss their concerns about this disconnect between the health care views of the electorate and elected officials. Both said they want to see Medicaid expanded and preserve protections for patients with pre-existing conditions.

Through her experience working in a free clinic based in Grundy County, Rice said she encountered many rural Tennesseans in dire need of affordable health care.

She described lawmakers’ refusal to expand Medicaid as a “war on the rural areas,” and said she believes it has much to do with the false stigma that poor rural Tennesseans on Medicaid are “lazy and looking for a handout instead of getting a job.”

“These are people who are part of the 381,000 Tennesseans who would have coverage if we expanded it,” she said. “All Tennesseans should be outraged about what’s happening.”

“It’s not like there’s not enough money to go around — we have lots of resources,” she added. “The people in power just don’t want people in rural areas to have them. It’s easier and cheaper to blame someone else with poor health.”

Mann discussed the affordability of her ACA marketplace plan compared to her family’s premiums before the ACA’s protections for pre-existing conditions went into effect.

Without protections for patients with pre-existing conditions, Mann’s husband, who was diagnosed as a Type 1 diabetic at age 13 and has previously suffered heart attacks due to complications, would once again face the same difficulties he encountered in the past when insurers were reluctant to offer an affordable plan. 

“They said, ‘No, we will not sell you any insurance. Your money is no good here,’ ” Mann said. 

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Rural health advocates again call for Medicaid expansion in Tennessee