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Michael S. Lottman: Editorial 2-22-13

SCAreadersSpeakOutI was truly dismayed to see the “Capitol Hill Review” article in last week’s issue that presented as unvarnished truth the assertion of the State Controller that the “Obamacare” health insurance program presents a financial threat to the State of Tennessee. This article, illustrated by a picture of our State Representative, continues the flow of falsely negative information about a bold but well-intentioned program that is now the law and deserves a fair chance to succeed.

In particular, it is just not true that the Obamacare program exposes our State to any excess costs or undue fiscal burden. Health care insurance under Obamacare is intended to be supported under three main programmatic sources, none of which requires a financial contribution from the State for at least the first three years. First, the assumption is that most elderly Tennesseans are now or can be covered by the Federally-funded Medicare program—which I and most other enrollees I know consider the best health insurance they have ever had. (Elderly individuals who may not qualify for full Medicare coverage should be able to fill any gaps with the other two parts of Obamacare.)

Second, for individuals above the poverty level who are unemployed, self-employed, part-time workers, or otherwise unable to secure affordable insurance elsewhere will be eligible to access a healthcare insurance marketplace or “exchange” where they will be able to compare a wide variety of policies and select one that meets their medical needs and ability to pay. Subsidies will be available to help pay for these policies for persons with incomes up to 400% of the Federal poverty level—for example, more than $95,000 for a family of four. These partial supports will leave purchasers to pay the balance, and are provided in the form of Federal tax credits that can be immediately applied to the cost of insurance. That is, no State money is involved. Tennessee has also avoided most or all of the administrative costs of running the State’s health insurance exchange, by ceding its responsibility to the Federal government. (So much for local control.) Last week Governor Haslam renounced even a partnership arrangement with the Feds, for reasons having nothing to do with financial responsibility, which remains with the Federal government regardless.

Finally, while persons now eligible for TennCare will remain so, coverage for “working poor” individuals and their families with incomes between 100% and 138% of the poverty level depends on the Governor’s (and possibly the Legislature’s) willingness to permit an adjustment of TennCare to include the people in this group. If these most vulnerable Tennesseans, estimated to number up to 200,000 or more, are not so included, it is unlikely that they can qualify for full affordable insurance under any other provision of the new law. Thus a substantial proportion of the people for which Obamacare was designed will be left without access to decent care, despite the fact that the Federal government is committed to pay the full cost of expansion for the first three years of the program and no less than 90% indefinitely. Even a number of very conservative governors in other States have concluded that they cannot afford to pass up this kind of money.

In addition, the Nashville Area Chamber of Commerce—as fiscally aware as any group that one might name—has come out in support of TennCare coverage for the working poor. The chamber cited, among other reasons, the creation of more than 20,000 new jobs to treat uninsured individuals and the need to secure additional funding in order to replace cuts in other sources of payment for uncompensated medical treatment. There are fears that hospitals in rural areas, and perhaps others, may have to close if they are forced to accommodate low-income patients without any means of adequate reimbursement—thus depriving all members of those communities, not just the working poor, of readily accessible treatment and emergency care.

It seems clear enough that there is no valid reason for Tennessee not to take the virtually cost-free step of making the needed adjustment in TennCare eligibility and accepting the 100% reimbursement—unless, that is, one thinks it is more important to express his or her opposition to “socialized medicine” (an over-used buzzword) or, for some, to affirm their dislike if not hatred of anything identified with President Obama (for reasons that are best discussed elsewhere). Should it not matter more that for no or minimal financial sacrifice, we can make life longer and better for many thousands of our fellow Tennesseans who cannot afford to protect themselves or their family members from the ravages of illness?

Of course, the fate of government programs—and even of the national and global economies—cannot be guaranteed in our troubled world, but are our hearts so hardened that we will bear no risk at all for the sake of the most vulnerable among us? Not to take the modest step of making health care available to all our citizens will erode our State’s vitality, self-respect, and moral standing, and will say to all the world that we are no longer Volunteers for anything but our own selfish interest.


Kingston Springs

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