On the surface, work requirements for TennCare may sound like a good idea.
Most Tennesseans are conservative with their tax dollars, so it stands to reason that we often view any kind of social service that doesn't come out of a church as being some kind of derogatory give-away. Similarly, many of us don't think it's good to disincentivise anyone's incentive to work.
Here's the rub.
TennCare covers an estimated 1.2 million low-income families and children, pregnant women, the elderly and people with disabilities. When you subtract the children, the mothers or fathers who are exempted because they care for children under age 6, the elderly over 65, the disabled and those receiving drug treatment, the number or "able-bodied adult enrollees who would be required to work would be a mere fraction - somewhere between 58,000 and 86,400, according to estimates from Beacon Center and legislative analysts, respectively.
And to make sure we find that fraction of TennCare recipients and ensure they spend 20 hours a week working, volunteering or in education programs, the state would spend an estimated $18.7 million a year.
Put your church mission-work hat on for a moment. How does a recovering opioid addict get a job without treatment? How does a person with a disability convince an employer that his disability won't raise the cost of the company's insurance plan? And if a disabled person doesn't get a job, how does she make payments on a car that she can use to get to another job when she's kicked off TennCare because she's not working? What about the 50-year-old clerk who was forced to give up her job for a few years to care for her mother with Alzheimer's?
TennCare recipients are not one-size-fits-all. TennCare work requirements, as proposed, pretty much are.
Now put your taxpayer hat on. What do we get for our estimated $18.7 million a year cost to make sure able-bodied poor people work so we can kick them off of TennCare? Answer: A negative. We spend $18.7 million to save $3.6 million.
The fiscal note prepared by the Legislature's Fiscal Review Committee estimated the actual price tag would include an additional $22.3 million in expenditures for case management costs, minus the estimated $3.7 million in state savings from disenrollments, based on the program starting in 2020.
In figuring the savings, the fiscal review research assumes that 37,169 non-working and non-exempt enrollees will fail to meet the work requirement, and 10 percent of those will be disenrolled - for a savings of $3.6 million in state funds. That $3.6 million was factored into the net cost calculation of $18.7 million.
The $18.7 million number irritated some Republicans. They questioned why TennCare officials would need to spend $200 to $300 per enrollee annually, including $100 per enrollee annually, for case management. The $100 would help affected enrollees find work, volunteer work or education to meet the requirement.
The Tennessee Justice Center, a Tennessee health care advocacy group, argues that the cost number is low-balled because it fails to take into account the need to recreate an in-person application and validation process that was eliminated in 2014 when the state put health care assistance applications online and eliminated several hundred staff positions.
The group notes that the state also will lose $7 million to $10 million in federal match - on top of the $18.7 million.
The resulting loss of $28.7 million to save $3.6 million also fails to account for the distinct possibility that people of all ages and conditions of disability could lose the very coverage that might actually help them get work - not because they are refusing to work, but because of bureaucratic red tape and even errors.
The bottom line is that to advance the political interests of a number of lawmakers - including gubernatorial candidate Beth Harwell who sponsors one such proposal - the state will spend $18.7 million, build a new bureaucracy, intrude on the lives of more than 1.2 million Tennesseans and give up nearly $10 million in federal match money - all to provide health coverage to 3,700 fewer people.
Whether you wear a what-would-Jesus-do church hat or a taxpayer hat, this proposal, on closer inspection, doesn't sound good at all.