Five candidates for Tennessee governor offered a glimpse of their potential plans to address the state's top health care issues during a forum in Nashville on Tuesday morning.
In barely an hour and 15 minutes, the candidates answered more than 20 questions on topics ranging from how to tackle the state's high rates of chronic diseases and the opioid crisis to Medicaid reform and even their personal strategies for staying healthy.
Concerns over health care costs reigned, which makes sense - a third of the state's budget goes toward health care, yet Tennessee notoriously ranks as one of the least-healthy states.
Tasty politics
The candidates were asked a light question about their food preferences. Here are their answers: What’s your favorite vegetable, and your unhealthy weakness? › Randy Boyd: broccoli; nachos w/ jalapenos› Karl Dean: lettuce; french fries/pizza› Craig Fitzhugh: carrots; hamburgers › Beth Harwell: arugula; pizza› Bill Lee: carrots, beet, kale juice; banana MoonPies
"We simply cannot afford the health we have, so the obvious answer is that we have to invest more in our health," said Republican Randy Boyd, former state commissioner of economic and community development, who was quick to note investing more doesn't necessarily mean more government spending.
Businessman Bill Lee, a Republican and chairman of the Lee Company, called the health care system "incredibly dysfunctional" and said his "goal would be to bring the competing interests together and put them on the same team to move forward with comprehensive reform."
He said the state must change its current trajectory or face a "tsunami of costs" that come with its burden of chronic diseases - like diabetes, high blood pressure and obesity. That change must come not through government spending, but by deregulation and engaging underutilized community partners and nonprofits, he said.
Since many chronic diseases stem from lifestyle choices, such as poor diet, limited exercise and tobacco use, the candidates said they want to improve education and target future generations to instill healthy habits early in life.
"If you're really going to change chronic illness, you have to change behaviors," said Karl Dean, a Democrat and former Nashville mayor. "I certainly would have benefited when I was younger if I learned healthy eating."
Democrat Craig Fitzhugh, House minority leader in the Tennessee General Assembly, said teaching efforts should also focus on how to cook and that eliminating areas where people don't have easy access to healthy and affordable food is an important piece of the puzzle.
"I'm concerned about the type of food that children eat outside the schools," he said.
Main talking points for Beth Harwell, Republican speaker of the House, included increasing physical activity in schools and incentivizing healthy outcomes through lower insurance premiums.
"Without a doubt, prevention is the key," she said. "We are passing legislation just this year to require more physical education in school."
Medicaid was one of the more partisan issues that cropped up throughout Tuesday's forum. Conservatives are wanting more flexibility from the federal government - perhaps through block grants - to run the program as they see fit, while the hope of expanding Medicaid was held only by the two Democratic candidates.
"I believe it was a huge mistake for the state not to do the Medicaid expansion," said Dean, who was echoed by Fitzhugh in promising to do everything within his power to bring those federal dollars left on the table to Tennessee.
Harwell also pushed Medicaid work requirements for able- bodied beneficiaries.
"We need to provide a safety net," she said, "but it doesn't need to turn into a lifetime entitlement."
The other candidates cautiously entertained the idea of work requirements for Medicaid - better known in the state as TennCare - saying it's worth looking into but could do more harm than good.
"The cost of actually monitoring and maintaining that program might be more expensive than the program itself," said Boyd, whose concern was shared by Dean.
Fitzhugh said the move to add a work requirement is "deceiving," because few able-bodied individuals are covered by TennCare, which provides health insurance to mostly low-income pregnant women, parents or caretakers of a minor child, children and individuals who are elderly or have a disability.
The need to improve health care access for rural Tennesseans, be it through recruiting more providers, supporting critical access hospitals and bolstering small-town economies, surfaced throughout the morning.
Several candidates suggested offering incentives to providers who commit to serving the rural population and telemedicine as potential solutions, but Dean was the only candidate to mention expanding rural internet access as a factor.
"We need to look at rural broadband if were going to have telemedicine," he said, taking another opportunity to mention that it's hard to attract providers to rural areas without Medicaid expansion.
Boyd was the only candidate to place a particular emphasis on mental health and said he is "startled" by the number of young people who are depressed and have considered or attempted suicide.
"We have got to put a bigger focus on mental health," he said. "If you don't have mental health, you won't have physical health."
Moderator Hallerin Hilton Hill concluded by invoking the Declaration of Independence and emphasized health care's role in Americans' right to "life, liberty and the pursuit of happiness."
"If the people don't feel like we're living well-lived lives, what do we have?" he asked.
U.S. Rep. Diane Black, another governor hopeful, did not attend Tuesday's forum. She also skipped a Tennessee Press Association forum and a televised education forum at Belmont University for what turned out to be a campaign fundraiser.
Contact staff writer Elizabeth Fite at efite@timesfreepress.com or 423-757-6673.