Editor's note:
Below are complete responses from the major candidates in the 2010 gubernatorial race to questions on health care.
The answers were by compiled for the Tennessee Newspaper Network, a content-sharing coalition that includes the Chattanooga Times Free Press and
newspapers in Memphis, Nashville and Knoxville.
Leading up to the Aug. 5 primary election, the Tennessee Newspaper Network has offered up questions and answers on issues of importance to Tennessee's next governor.
An edited version is in the print edition, but the complete version is presented below.
1. One study says the health care reform law could add as many as 500,000 people and $1.5 billion to TennCare's budget within five years. How would you prepare for this in your first term as governor?
Mike McWherter: I believe it is imperative for the next governor to work closely with our federal delegation to ensure Tennesseans are not saddled with the burden of unfunded federal mandates. Many components of the new bill will not go into effect until 2012 and federal agencies have yet to craft policies to address the changes. As these new policies are crafted, I will work with our congressional delegation to make sure these policies do not place undue burden on the taxpayers of Tennessee.
Bill Haslam: First of all, we must pursue every available option in order to prevent the damaging impact of this legislation. Even before Washington forced this costly unfunded mandate on the states, Tennessee was facing a budget situation more difficult than any in modern memory. I'll do whatever I can to fight this legislation, and I will not let TennCare ever threaten the fiscal health of our state again.
In general terms, I'll work to lower healthcare costs in Tennessee by emphasizing personal responsibility and preventive medicine, stamping out TennCare fraud and abuse, and passing meaningful tort reform that will allow doctors to stop practicing defensive medicine.
Ron Ramsey: I wouldn't. It is my intention that Obamacare and its massive unfunded mandates never reach Tennessee. Governor Bredesen called it "the mother of all unfunded mandates" and he is correct.
As lieutenant governor, I've challenged this unconstitutional health care mandate as much as I legally can. I've passed a resolution urging our Attorney General to sue the federal government on behalf of Tennessee but he chose not to fight for us. I pressed for legislation which cleared the path for Governor Bredesen to sue unilaterally. As governor, I will finally have the full suite of powers to stop this infringement of our personal rights and our state sovereignty.
With Tennessee facing an estimated $1.9 billion budgetary shortfall next year, Tennessee needs a strong governor to push back on this budget busting disaster so that we can balance our state budget. I've said publicly that I will hire outside pro bono council, if necessary, to stand up for our state's sovereign rights. My position remains firm.
Zach Wamp: When elected, I will do everything in my power to fight the Obama/Pelosi healthcare mandate, including challenging the legislation in court so that Tennessee is not burdened by this new enormous cost. Tennesseans are against this onerous legislation, which requires new spending by states that are already facing severe budgetary pressures. I will work to rally the nation's other governors on this issue to push the federal government back.
2. Do you support efforts to challenge the health care reform law in the courts? On what basis?
McWherter: Due to the fact that our state is facing a 1.5 billion dollar budget shortfall, I tend to believe that using taxpayer dollars on lawsuits like these are a waste of time and resources. I agree with Senator Bob Corker's position that efforts to repeal the bill are futile and that we should focus our efforts on incremental fixes to ensure Tennessee taxpayers are not stuck with unfunded federal mandates.
Haslam: Yes. This federal legislation usurps our Tenth Amendment right to govern our state according to our own priorities.
Ramsey: Yes. The law's most glaringly unconstitutional component is the individual mandate. Why? Because those who refuse to purchase insurance would be fined, and refusal to pay would be a crime, punishable by fines or incarceration. Here's why that's unconstitutional:
States have the authority to make laws for the health, safety and morality of citizens, while the federal government has very limited jurisdiction in this area. If the U.S. Constitution does not grant a power to the federal government, the 10th Amendment reserves it to the states or the people.
Many constitutional provisions grant powers to the federal government. Supporters of the individual mandate point to the Tax and Spending Clause and the Commerce Clause. But no constitutional basis for the individual mandate can be found in either. Those who refuse coverage don't receive federal dollars, so the mandate cannot fall under the spending portion of the Tax and Spending Clause.
In addition, it can't be a tax. The federal government may only levy excise, capitation and income taxes and the mandate does not fall into any of these categories.
Finally, it's not covered by the Commerce Clause because those who declined to buy mandated insurance are not engaging in commercial activity, so there's no interstate commerce.
Wamp: I believe we must fight the healthcare reform law on three fronts: through the courts; through legislative proposals like the ones considered this year in the state General Assembly; and at the ballot box in 2010 and 2012. As governor, I will challenge the healthcare reform law based upon our state sovereignty rights and the 10th Amendment to the United States Constitution."
3. As governor, would you try to convince Congress to repeal any portions of the health care reform law? If so, which parts?
McWherter: There are many components of the health care reform bill that will not go into effect until 2012 and federal agencies are still in the process of crafting new policies. As these policies are written, I will work with our federal delegation to ensure that Tennessee taxpayers are not left picking up the tab on another unfunded federal mandate. Former Senate Majority Leader Bill Frist said, 'You hear a lot of people on the extreme say that socialized medicine is going to come in and control everything. Socialized medicine is where the government owns the hospitals. They own the doctors and they decide how much people are getting paid. And that's not what's in these bills.' I agree with Dr. Frist - we need to have an open honest discussion about these measures and work together to provide affordable quality healthcare for Tennesseans.
Haslam: We should replace it with a better bill. We can't talk about increasing access without addressing the cost side of the problem. We need real reform based on market principles that will lower costs, increase access, and improve health outcomes.
Ramsey: The entire law must be repealed but the best way to do so is focus on the parts which 1) are the most unconstitutional and 2) destroy our chances for a healthy economy. I covered the unconstitutional portion in the question above so I'll tackle the second issue here:
Obamacare will decimate small businesses across the country with massive new regulatory requirements. In 2012, businesses will be required to send 1099s to anyone who is paid $600 or more for products or services. Companies will have to send 1099s for virtually every product or service they purchase, creating a mountain of paperwork which hits small business disproportionately. The cost of compliance will be far higher than any additional taxes the IRS might collect through this regulation. The National Federation of Independent Business recently authored a Wall Street Journal op-ed denouncing Obamacare for its negative impact on small business and announced that NFIB will join with states who have decided to sue. As a small business owner, I understand the horrific effect this will have on businesses across Tennessee. In an economy where people need to get back to work, our job creators won't be growing and creating jobs, they will be struggling to survive.
Wamp: "I support repealing the entire bill and replacing it with a bill that focuses on lowering the cost of healthcare. I support laws that protect people with pre-existing conditions from being denied access to healthcare and support finding new ways to increase competition in the healthcare market that will lower costs for our families, communities and small businesses."
4. How would you deal with the rising costs of providing health insurance to state workers?
McWherter: I know from running my own business how significant the cost of providing health insurance can be and there are many steps we can take to address this issue. For instance, in my business we promote the use of generic drugs whenever possible. We should also focus on preventative care such as promoting healthier lifestyles for many of our state employees. We need to concentrate less on penalizing those who become sick and more on ensuring that our state workers take care of themselves and live more active and healthy lifestyles.
Haslam: As Mayor of Knoxville, I lowered the costs of providing health insurance for city workers and have worked to improve health by introducing incentives for personal responsibility into the system and emphasizing preventive care. As governor, I would take a similar approach.
Ramsey: The solution to rising costs for state workers is the same as that for all Tennesseans. We need the federal government to loosen the rules around Medicaid to give states more flexibility in how we implement the program. We could introduce co-payments and preventive health measures in Medicaid aimed at promoting personal responsibility.
Second, we need further medical malpractice reform. In 2008, I helped pass a bill that makes it harder for plaintiffs to sue. Plaintiffs must now give a 60-day notice before filing a malpractice suit and must get a certificate of merit from a medical professional that the lawsuit has merit. The number of malpractice suits filed in Tennessee has dropped 60 percent.
This year I proposed a bill that capped noneconomic, punitive damages in medical malpractice suits at $1 million. This is one way to reduce the waste and cost associated with physicians practicing defensive medicine. This strategy will reduce costs for everyone.
Wamp: One of the first ways is to launch a strong new emphasis on prevention and wellness. That's why my 20/20 Vision For an Even Better Tennessee focuses on preventive healthcare to help make Tennessee a healthier state and to help lower costs through exercise, routine physicals checkups, prenatal care, mammograms and basic health maintenance. Our children, in particular, are not active or healthy enough. Chronic obesity, Type II diabetes and hypertension at adolescence must be addressed early to prevent both the "life and death" consequences of these diseases and the long-term financial cost on all of us.
5. Tennessee has the nation's fourth-highest death rate from lung cancer. What, if anything, would you do to reduce smoking in Tennessee?
McWherter: It's unfortunate to see so many Tennesseans fall victim to lung-cancer when the dangers of smoking are so well-known. Scientists across the world have overwhelmingly agreed smoking cigarettes is hazardous to human health and costs taxpayers millions of dollars. I applaud the Bredesen administration for enacting the Non-Smoker Protection act of 2007, but more needs to be done. We also need to focus on preventing underage smoking through educational outreach and ensuring gas stations and other vendors are not selling to minors.
Haslam: I believe a focus on personal responsibility, prevention, and wellness is the best means for creating the right incentives to dissuade people from smoking. In the reforms I made to Knoxville's city health plan, we actually provide specific incentives and benefits for those who do not smoke as well as smokers who take cessation courses. As governor, I will use the bully pulpit to promote healthy living.
Ramsey: This state and nation has made great strides in fostering a healthier culture regarding smoking. My generation smokes less than my parents' generation and my children's generation smokes less than my own. Tennessee has ensured that vendors card those seeking to purchase tobacco and have provided a toll free tobacco quit line 1-800-784-8669. Tennesseans have done a lot on this issue, but it ultimately relies in most part on personal responsibility. To learn more, go to http://health.state.tn.us/tobaccoquitline.htm.
Wamp: Again, prevention is key. As governor, I will launch and lead a new public awareness campaign focused on prevention and wellness, including information about the obvious dangers from smoking.
6. Tennessee's infant mortality rate of 8.7 deaths per 1,000 live births is far higher than the national average. What would you do to reduce infant mortality?
McWherter: I certainly would not propose cutting funding for infant mortality programs like the State Senate's republican leadership did during the recent budget debate. As governor, I will work to make sure that mothers have access to quality nutrition and prenatal care. I will also use the bully pulpit to educate expectant mothers on the importance of prenatal care and the dangerous effects of substance abuse during pregnancy.
Haslam: This is a critical issue for our state, and I think the right approach not only includes efforts in the healthcare sector, but also in education. Former U.S. Senate Majority Leader Bill Frist helped lead a 2008 study that demonstrated not only that babies born to mothers with less education are less likely to survive their first year of life than those born to better educated mothers, but that this disparity is larger in Tennessee than in any other state. Improving our schools and increasing educational attainment rates must be an important part of any attempt to address infant mortality.
Ramsey: Tennessee taxpayers spend over a billion dollars annually on the Department of Health and the Department of Children's Services. We are not getting much for our investment. Those two departments should be combined and given strict oversight from the governor himself. DCS is the most poorly run department in state government. Our infant mortality rate is sky-high yet here's just a few of the bureaucratic departments within DCS: Office of Child Safety, Office of Family and Child Well-Being, Office of Finance and Program Support, and an Office of Regional Support that oversees 13 regional offices. The solution to reducing infant mortality in Tennessee is not spending more money, it's firing those in place and providing leadership, accountability and priorities for the billion dollars available to help the most vulnerable among us. I will do that as governor.
Wamp: I have long been a leader in combating infant mortality and low birth weight and will convene experts in this field and raise statewide awareness to address these challenges. More information and support for expectant mothers is key, and we must encourage more routine checkups, prenatal vitamins, better diet and exercise as proven pathways toward healthier pregnancies.
7. Tennessee spends about $1.5 billion annually on obesity-related problems. What, if anything, would you do to reduce obesity in the state?
McWherter: I will continue to support the Office of Coordinated School Health, which is the only statewide program in the country dedicated to improving student health. I will also look into expanding programs that get fresh produce in schools; incentives, such as lower insurance premiums or co-pays, for state employees to lose weight and be more fit; and incentives for TennCare recipients to lose weight and be more fit. Finally, I'll look into initiating programs to fight food deserts, which are areas in which residents do not have access to healthy foods in their grocery stores and restaurants.
Haslam: Obesity is a real problem in our country, and Tennessee's childhood and adult obesity rates are among the highest in the nation. This is a concern because obesity is often tied to chronic conditions such as hypertension and Type II diabetes. I believe we must begin to address obesity by working to create incentives in our healthcare system for personal responsibility and making sure we are emphasizing prevention and wellness. We should work with our schools and community groups to make certain that we offer lifelong opportunities for exercise.
Ramsey: Use the bully pulpit, through the Governor's Council on Physical Fitness and Health, to encourage a healthy diet and exercise. The solution to this problem is not complex but it takes a similar cultural effort to that which has dramatically reduced smoking in today's society.
Wamp: Unfortunately, we have too many children on high blood pressure medicine and too many Tennesseans with Type 2 Diabetes. I've often said that the most effective anti-depressant in the world is sweat, and we need to get Tennessee moving again. As governor, I will aggressively promote the benefits of exercise and an active lifestyle and better nutrition and diet as the most effective weight reduction techniques and the most basic first step toward a healthier and more productive Tennessee.
8. Do you support an increase in the soda tax to discourage consumption and fund health programs?
McWherter: On principle, I do not support any tax increases.
Haslam: No.
Ramsey: No. It's not the governor's job to force lifestyle changes through taxation. That is an ultra-liberal idea similar in concept to a bill we defeated in Tennessee in 2010 by stopping legislation that could have mandated calorie counts to be listed on restaurant menus. Government should not use its taxing power to influence what type of soda or cola citizens choose to drink.
Wamp: No. I would not support an increase in this tax. More health awareness and information for consumers is the answer, not higher taxes. I will work with the legislature to find better ways to approach this real problem than a tax on sodas. We don't need new taxes, but we do need a grassroots effort to reduce sugar in the diet of young Tennesseans and improve physical fitness in our schools.
9. Would you increase funding for safety-net hospitals, such as Metro General in Nashville and the Med in Memphis?
McWherter: As governor, I would carefully examine and assess any requests for funding from safety-net hospitals to ensure that taxpayers were not unfairly shouldering the costs of healthcare. Unfortunately, those without health insurance often show up at emergency rooms to receive care because they won't get turned away. As governor, I would examine alternatives to the costly process of administering healthcare to patients in emergency rooms. Our next governor must work closely with the federal government to make sure Tennessee is reimbursed appropriately for residents who live outside our state and take advantage of our healthcare system.
Haslam: Our charity hospitals are incredibly important to communities and regions across Tennessee. As governor, I will make it a priority to help our charity care system develop a sustainable model. I will work with hospitals and their stakeholders to develop specific strategies for long-term viability, and I will be hands-on and fully committed until such plans are in place.
Ramsey: As governor, I will work hard with city and county leaders to formulate a responsible, long-term plan to keep the safety net hospitals viable. However, I will not commit to obligating every Tennessee taxpayer to unlimited financial support of safety net hospitals. Obama's healthcare mandates will exacerbate the problems of the Med, Metro General and hospitals throughout our state. I am the only candidate for governor who has experience passing balanced state budgets without an income tax. I will use this experience to help the safety net hospitals and Level I trauma centers without placing onerous new tax burdens on the people of Tennessee.
Wamp: Our safety net hospitals like the Med in Memphis, Erlanger in Chattanooga, Metro General in Nashville and others are often the vital links in providing urgent medical care to many Tennesseans, and we simply cannot afford for them to fail. I am the only candidate for governor who has signed the pledge supporting the Med in Shelby County. We need a governor with the right experience and backbone to do what is needed to support our safety net hospitals and pursue maximum federal Medicare reimbursements for their indigent care. As governor, I will also push to make sure neighboring states are contributing their fair share to Tennessee hospitals that are treating their residents.
10. Hospitals agreed this year to pay a voluntary assessment to avoid deeper cuts to TennCare. Do you believe the assessment should be extended?
McWherter: Frankly, with all the changes at the federal level we don't yet know what impact the reform will have on TennCare. At this point, I don't want to speculate, but as governor I will work with the Hospital Alliance of Tennessee, the Tennessee Hospital Association and other parties to assess the situation resulting from the federal reforms. These groups have been instrumental in working with the state to control healthcare costs and I would like to commend their efforts. I will continue to work with these organizations to find innovative solutions to address our healthcare challenges.
Haslam: This year we had a truly unique situation where an industry came together and made it clear to the legislature and the governor that they wanted and needed this assessment. Next year, we'll evaluate the circumstances that exist at that time, talk to hospital industry leaders and other stakeholders, and make sure we come up with an appropriate, fiscally responsible solution. First and foremost, I will make sure TennCare never again threatens to bankrupt our state.
Ramsey: No. I believe the assessment should be examined annually to see if it is necessary. Should the effected hospitals decide the assessment is no longer required, the legislature should not lock them in to paying it. Over the long-term, it will be very difficult for the hospitals to continue the practice of providing a match to federal dollars without passing those costs on to patients.
Wamp: I will sit down with the leaders of the hospitals when I become governor to seek their advice and counsel on this issue. But clearly, we must continue to work together to find ways to continue to offer affordable, high-quality health care to Tennesseans.