“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” — dr Martin Luther King Jr.
The American public is highly aware that rising health care costs are a major problem for our citizens. In fact, a 2022 poll ranked the issue as the second most important concern of most Americans, right after the economy.
However, most Americans are unaware that the US trails every other democracy regarding health care coverage. In fact, that lack of insurance is one major reason why numerous studies have rated our health financing system very poorly versus other developed nations, which generally do not use our employer-based health insurance model. Norway, the Netherlands and Australia were ranked highest, with the US coming in dead last. Further, the states that have not expanded Medicaid have even larger problems than our country as a whole.
Unfortunately, when it comes to health insurance, Tennessee ranks high (No. 9) in the proportion of uninsured people of versus other states. One reliable source, the Henry J. Kaiser Family Foundation, indicates that more than 11% of the Tennessee population — nearly 800,000 residents — is without coverage.
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As things stand, Tennessee is covering 1.4 million residents — 26% of the non-elderly population — as a result of the Affordable Care Act. But if the ACA were fully implemented as Congress intended, there would be 1.8 million people covered, a substantial increase.
And the worst part is that Tennessee could very easily cut that number drastically, if state government chose to do so. If they simply took the federal matching dollars and expanded Medicaid, many of the residents without coverage would then be insured and able to get the health care they so badly need.
How did this happen?
Let’s look at the history of how this miserable situation came to be. When the Affordable Care Act was first passed, the clear intention of Congress was that every state would expand their Medicaid programs. To accomplish this goal, Congress put a “poison pill” into the legislation indicating that if Medicaid was not expanded to cover everyone under 138% of the poverty line, all Medicaid funding would be lost.
However, in a narrow decision with questionable reasoning that seemed to be based more on politics than precedent, the right-wing Supreme Court found that clause to be unconstitutional. That ill-informed decision resulted in the uneven health care coverage we see today, with 12 GOP-dominated states (mostly in the solid-red South) still failing to expand Medicaid to cover more people, even though the federal government is paying for 90 % of the tab.
In fact, initially, the federal government offered to pick up 100% of the tab for the first three years, so there would have been no cost at all to Tennessee to cover more residents. But that is not what the Tennessee governor and legislature wanted, or they would have done it 10 years ago. Instead, they made and continue to make a conscious decision to let lower-income white, Black and Latino residents suffer.
And don’t be fooled by the fallacious “we don’t have the money” argument. The money was found by 38 red and blue states. All states clearly have the money to cover more of our neediest citizens and ensure that they get their basic health care needs met. What we do not have is political leadership in Tennessee that cares about these lower-income citizens.
Jack Bernard was the first director of health planning for Georgia. As a corporate executive with health care corporations, he did planning and/or cost containment for many hospitals in Tennessee.