Tennessee's citizens rank third from the bottom of the 50 states in measures of physical and medical well-being, a comprehensive new study shows. That's no surprise in a state which limits TennCare/Medicaid coverage to citizens below the federal poverty level and leaves about one out of four working Tennesseans without health insurance.
Even among Tennessee workers with private or employer-based insurance, a large percentage carry just skeleton, high-deductible coverage which leaves them grossly underinsured and vulnerable to medical catastrophes and medical bankruptcy.
So what is the response of our myopic Republican-majority lawmakers to so many constituents' ongoing medical insurance crises? Regrettably, their view is one of disdainful and uncaring negligence toward Tennesseans' health care plight, to an extent that borders on malfeasance, if not deliberate cruelty.
Virtually all of the Legislature's Republicans oppose President Obama's proposed expansion of Medicaid to 138 percent of the federal poverty level, though the federal government would finance that expansion and bring about 180,000 more low-income working family members in Tennessee under Medicaid coverage. As for the rest of some 900,000 working but uninsured Tennesseans, they seem likely to adopt the malignant bill proposed by Republican Rep. Vance Dennis, a Savannah attorney who is seeking to bar Tennessee-based health insurance companies -- including the state's largest nonprofit insurer, BlueCross BlueShield -- from offering coverage under the state insurance exchange scheduled to open in January.
The state's insurance exchange, which will include a federal model plan that covers nearly half of federal employees, will be required to provide affordable, comprehensive health insurance at flat community rates to uninsured Tennesseans not covered by Medicaid for the very poor, or Medicare for seniors over 65, or federal care for veterans.
Individuals and families with incomes of up to four times the federal poverty level (i.e., $94,400 for a family of four) would receive a wage-adjusted subsidy under the Affordable Care Act to make coverage affordable. Accompanying the creation of state insurance exchanges also will be federal bans, at long last, ending pre-existing conditions for adults (that ban already applies to children's conditions) and ending lifetime limits on insurance coverage.
Dennis and the six majority Republicans on the House Insurance and Banking Subcomittee who passed Dennis' bill out of their committee last week on a 6-2 vote clearly want to sabotage the ability of insurers in Tennessee -- and, they hope, those in other states -- from participating in the state insurance exchange. Indeed, they want to sabotage the whole idea of such an exchange, in Tennessee and across the country.
It's doubtful that their obtuse and injurious idea can succeed. A state attempt to bar insurance companies from participating in an insurance exchange ordained under the federal Affordable Care Act, or Obamacare as it's known, couldn't be expected to pass constitutional provisions. The U.S. Supreme Court has already upheld the constitutionality of the ACA and its mandate for uninsured citizens to purchase health insurance. Though that ruling said state governments do not have to establish the insurance exchanges, it left the federal government free to do so in states that refuse to create such exchanges.
The question, then, is why Republicans remain so ideologically opposed to the ACA, which is simply designed to lift from citizens the burden and fear of medical catastrophe, unaffordable care and potential bankruptcy and early death. What kind of lawmakers would wish burdens on their citizens?
Dennis says he wants to save "billions and billions" of dollars from being spent to provide universal care, but his assumption is wrong. Congress' own nonpartisan budget office has long confirmed that the ACA would save hundreds of billions over the pre-existing status quo of uncoordinated care and unrestricted profit-gouging by a greedy health -care industry that cherry picks the healthy, spikes care costs, and leaves far too many who are unable to pay to die early.
Anyone who doubts the humane value of expanding access to health care in Tennessee need only read the excellent front page account by The New York Times yesterday of the heart-breaking telephone lottery held periodically by TennCare which provides rare winners among "the medically desperate" a chance to receive needed but unaffordable care.
To read "Tennessee Race for Medicaid: Dial Fast and Try, Try Again," go online at http://www.nytimes.com/2013/03/25/us/tennessee-holds-health-care-lottery-for-the-poor.html?hpw.
If this is what heartless Republicans want more of, Tennesseans should rebel in the streets.