Tennessee Rep. Jim Cooper (D-Nashville) has signed on to legislation that would allow Tennessee to expand Medicaid with 100 percent of costs covered for the first three years — an opportunity the state missed by not expanding Medicaid following the passage of the Affordable Care Act.
Under current law, the federal government would cover 90 percent of Medicaid expansion costs in Tennessee. Had Tennessee expanded Medicaid nearly five years ago following the passage of the Affordable Care Act, Tennessee would have received the 100 percent federal match that was guaranteed to states that expanded between 2014 and 2016. Beginning last year, the federal match phased down to 90 percent, which is guaranteed through 2020.
Cooper’s legislation, the Incentivizing Medicaid Expansion Act, would essentially renew the deal for the 14 states that have yet to expand Medicaid, giving them a second chance to make a common-sense step and receive the maximum amount of federal dollars. After three years of 100 percent federally funded expansion, the federal government would pay 95 percent for the fourth year, 94 percent for the fifth year, 93 percent for the sixth year and 90 percent for each year thereafter.
“The Tennessee state legislature should have expanded Medicaid years ago, but it’s better late than never,” Rep. Cooper said in a press release. “We’ve turned down billions of dollars, but this is a chance to fix our mistake. This bill would give our state zero excuses not to act now.”
Medicaid expansion has been hailed as a bipartisan milestone in a handful of other deep-red states. But in Tennessee, the Republican-controlled legislature blocked any expansion efforts introduced by Democrats as well as Insure TN, the plan introduced by Republican Gov. Bill Haslam.
Tennessee’s recently inaugurated new Governor, Bill Lee, disconnected from the economic realities of Tennessee’s working families, has made his opposition to Medicaid expansion clear. He’s instead suggested, without giving any meaningful detail, that he will “seek ways to lower health costs and premiums.” Based on data from expansion states, we know that Medicaid expansion would lower premiums for the 228,000 Tennesseans enrolled in insurance through Tennessee’s marketplace.
Some 90 percent of rural hospital closures have occurred in states that have not expanded Medicaid — and Tennessee leads the nation in rural hospital closures per capita. One of our state’s most recent hospital closures, Mckenzie Regional Hospital, had a patient coverage rate of less than 4 percent prior to closing. On top of drastic declines in uninsured rates overall, Medicaid expansion has had a disproportionately positive impact on rural areas compared to metropolitan areas. Data also shows that expansion states have seen uninsured rates for low-income adults in rural areas decline three faster than states like Tennessee that are still holding out.
Tennessee has missed out on $7 billion — $1.4 billion per year — since 2014 by not expanding Medicaid. Based on a University of Tennessee study of former Gov. Bill Haslam’s Insure Tennessee proposal (a more conservative version of Medicaid expansion), 15,000 jobs would be created, which would pump $1 billion in federal matching dollars into local economies.
The greatest argument for Medicaid expansion is simple: Nearly two-thirds of Tennessee residents support Medicaid expansion. If that support was reflected in the General Assembly, legislators would have enough votes to override a veto by Governor Lee.
Cooper’s words are true — “The bill would give our state zero excuses not to act now.” But unfortunately, despite enjoying their own government-sponsored healthcare for themselves and their families, Republican legislators have continually found excuses to deny the same coverage to 300,000 Tennesseans. For the past five years, Tennessee Republicans avoided doing the right thing, financially and morally, and simply watched as Tennessee’s opioid epidemic decimated rural communities, as 10 hospitals shut their doors, and as countless families took on overwhelming debt due to unexpected medical emergencies.
Regardless of whether Rep. Cooper’s Incentivizing Medicaid Expansion Act passes, Medicaid expansion remains, indisputably, the most publicly supported and impactful step Tennessee can take to improve healthcare outcomes and quality of life for Tennessee families, and Tennessee Democrats remain committed to making it happen in bipartisan fashion.