Answers to Speaker Harwell’s Concerns with Insure Tennessee
(Another Game of Whack-a-Mole)
In an interview with The Tennessean’s Editorial Board, Speaker of the House Beth Harwell voiced several
concerns about Insure Tennessee. However, her worries are misguided and inaccurate. Below is a list of
the issues that she raised during the interview, followed by explanations of why she can rest easy about
her concerns.
“We are dealing with a political issue. This is Barack Obama, he is not popular in this state…. And even
less popular than him is Obamacare.”
It is Speaker Harwell’s job to make sure that the members of the House vote on what is right for the
state over their political ideologies. For Speaker Harwell to use the fact that this is a “hard sell” as an
excuse is unacceptable. She is in a position to educate her colleagues on the issue so that they can move
beyond their distrust of Obamacare, and to show them that Insure Tennessee is different. She is in a
position to make sure the House is loving Tennesseans more than they are hating Obama. Other
conservative states – Arkansas, Arizona, Ohio, Montana – have moved beyond their distrust of
Obamacare to accept the federal dollars to improve their state’s health and economy. To say that
Tennessee couldn’t do the same is an insult to our elected officials.
“We didn’t have the votes, that’s the reality.”
The Speaker of the House is elected to lead. It is difficult for someone to lead if they have never stated
where they stand on an issue. Speaker Harwell has never come out for or against Insure Tennessee, and
instead of making sure she is educating the members of the House, she is hiding behind excuses and
distractions. Her early public doubts about the Governor’s plan became a self-fulfilling prophecy during
the Special Session. Her failure to support the plan sent a message to her members that they would be
sticking their necks out on their own if they voted for it.
Speaker Harwell admits there were 43 “yes” votes for Insure Tennessee – and that’s without her lifting a
finger. By our count, there were 28 members that were undecided on Insure Tennessee. If she stepped
up as a leader, she could easily have turned 7 of the 28 undecided votes into “yes” votes by making sure
they knew the facts and had her support. Instead, Speaker Harwell stepped back to watch the
Governor’s plan die without even getting to a vote by the full House.
“If we’re going to be successful with Insure Tennessee, it’s going to have to be part of an overall
package of TennCare reform in our state… We need to either put people onto another type of
program, a safety net program, or we need to reduce benefits.”
As it is, there is very little that can be cut from TennCare. The program is already at its bare minimum.
The only way Tennessee could cut back TennCare more is to cut children off the program. Is that what
Speaker Harwell is advocating for?
We might not be able to end the program, because either the federal government won’t let us, or it
might lead to a lawsuit.
The US Department of Health and Human Services Secretary Sylvia Burwell wrote a letter to Governor
Haslam saying that the state may end the program at any moment. The Tennessee Attorney General has
said that the state can pull out at any time. The Supreme Court decision that allowed states to opt out of
Medicaid Expansion said that states that opt into it can pull out at any time.
Many years ago, TennCare cut people off without properly considering whether they were eligible for
TennCare in other ways, as required by law. At the time of the 2005 cuts by Governor Bredesen, the
court found that the state had a process in place to make sure that people were protected from unfair
and inaccurate terminations. As Darin Gordon, head of TennCare, said in the Senate Commerce hearing
in March, TennCare is well aware of what the law requires, and they have a workable plan for complying
with it, should it become necessary to end the program.
There is no enforcement of paying co-pays.
For people who are on Insure Tennessee and who make above the poverty line, they must pay their copays and their premiums, or they may be dropped from the program. For people below the poverty line,
they do not need to pay premiums, and they have very few co-pays. This hasn’t been a problem in other
conservative states who are implementing this law.
We have to wait and see the decision of the US Supreme Court case King v. Burwell.
If King v. Burwell finds that states do not have the ability to offer people financial assistance through the
federally-run Marketplace, then our need for Insure Tennessee will be even greater because the number
of uninsured Tennesseans will rise, hospitals will be even more at risk, and our health care system would
be in serious danger.
We should limit the prescriptions for people on TennCare, and end catastrophic care so that only
preventative care is provided.
Tennessee already has one of the most restricted prescription programs in the nation. Disallowing
people with severe health needs and multiple chronic issues to get the medicines they need does not
solve any problems. It’s unmanaged care, and it increases cost for the state and federal government.
To give people only catastrophic care – which means that their hospital visits would not be covered –
would mean that hospitals would have to even larger uncompensated care numbers. This would be
devastating for hospitals, and would cause many more to close. And the hospitals would shift this cost
to those of us who are insured. No other state Medicaid program in the nation has done this despite
budget constraints because it doesn’t work
Too many people would enroll in the program.
There are potentially 470,000 Tennesseans who are eligible for Insure Tennessee, but the administration
predicts that 280,000 would enroll in the first two years. If more than the expected amount enroll, then
the federal government will pick up the cost, and the hospitals will pick up the remainder. There will be
no Tennessee tax dollars put on the line. Also, we can pull out at any time.
The start-up cost is $7.8 million.
The hospitals have agreed to pay this, and TennCare has said that while there is a start-up cost, the
savings that the state will see in the first year will more than cover the start-up cost.
There aren’t enough doctors to support the newly insured population.
Speaker Harwell’s concern about whether there would be enough doctors to handle the new population
is not echoed by those who work in the health care industry. The Tennessee Medical Association, the
Tennessee Nurses Association, the American Heart Association, the American Diabetes Association, the
American Cancer Society, the Tennessee Academy of Family Physicians, the Tennessee Primary Care
Association, the Tennessee Public Health Association, and hospitals across the state all support Insure
Tennessee, and have not raised this as a concern.
“I’m open to ideas to provide care to these people that will truly make them healthier.”
The solution is in your hands. Insure Tennessee will provide care and financial peace of mind to 280,000
hard-working Tennesseans, its “Healthy Incentives” program will incentivize healthy behavior, the plan
will allow hospitals in rural areas to stay open so that all Tennesseans will be able to have access to their
services, and this can all be accomplished without Tennesseans paying any extra taxes.