THE TENNESSEAN | Medicaid expansion has been a contentious topic since the Supreme Court’s 2012 decision holding mandatory state participation was unduly coercive. And the arguments against expansion are well-founded: Does the federal government really have enough money to fund this? What happens if the money runs out? We have tried this before and it was too expensive!
This last point sounded especially loudly in Tennessee; just ten years ago over 170,000 disenrolled from TennCare.
However, we have seen first hand that healthcare costs are a zero sum game. Removing insurance does not remove disease. Shifting costs away from the state in the form of insurance coverage only moved these expenses to hospital systems, which continue to provide emergency coverage to all Tennesseans regardless of insurance as required by federal law.
As a result, Davidson County alone saw as much as an 18 percent increase in emergency room visits and hospitals saw a 60 percent increase in their uncollectable debt.
Tennessee needs a solution that can address these questions of cost while considering the specific needs of Tennesseans. What Governor Haslam has negotiated with Insure Tennessee is just that. What he is proposing is not the cookie cutter Medicaid Expansion offered under the Affordable Care Act. It is a Tennessee-specific solution to close the coverage gap left between subsidies offered under the ACA and Tennessee’s current Medicaid coverage.