Where can health care go from here?

Hank Hayes • Oct 1, 2018 at 8:30 AM

KINGSPORT – The Tennessee Hospital Association (THA) hasn’t gotten what it’s wanted from the GOP-controlled General Assembly in recent years – namely Medicaid expansion – but still sees opportunity in the 2018 state elections.

The opportunity lies in the fact that about 30 new state lawmakers will be elected and a new governor will take over for term-limited Republican Bill Haslam.

“We’re not saying they are going to be Democrats, but they are going to be new faces … and new voices … It could be a different time now. We’ll see,” THA President and CEO Craig Becker said in a recent meeting with members of the Times News Editorial Board.

Becker stressed THA will not be making an endorsement in the gubernatorial race although Democrat nominee Karl Dean has advocated Medicaid expansion.

“We think (Republican nominee) Bill Lee, even though he said during the primary he wouldn’t go for full expansion, he’s talked about doing some kind of enhanced coverage so we’ll see what that is. We don’t know yet what that is,” Becker noted. “Hopefully, Bill Lee will talk about something comprehensive.”

Becker disclosed THA’s polling found two thirds of Tennesseans think health care is one of the major issues in the gubernatorial race. That may stem from the fact that 10 rural hospitals in the state have closed, Becker added.

“It’s mostly about money, not being able to keep it open because they have high uncompensated care, they have a lot of folks on TennCare, it’s particularly bad out in West Tennessee,” Becker said of the closings. “McNairy County and Brownsville, they have nothing now. It makes a big difference in economic development because they’ve got that (industrial) supersite out there (in Haywood County), and businesses say ‘tell me about your schools, tell me about your hospital’ and they can’t say anything about the hospital … The urban hospitals are also getting stressed particularly because of the high uncompensated care. Under the Affordable Care Act, we took some significant cuts to help pay for that and the whole idea behind that was we would get coverage and we never got that coverage because the Supreme Court said you could opt in or opt out, and our state chose not to opt in, it’s still possible that it could opt in and depending how the election goes, we still want to have that discussion if it’s a blue drop or a blue ripple.”

THA, said Becker, expects more hospitals to close. “I know of at least four or five right now that are on the brink,” he pointed out. “Some have been bought by venture capitalists who don’t know what they are going to do with it … those communities are desperate. They will take anything to keep them open.”

THA’s polling, according to Becker, also showed 75 percent of respondents said partial Medicaid expansion would be acceptable, particularly if it was tied into something like behavioral health or opioid treatment.

Becker insisted that Medicaid expansion, which was rejected by state lawmakers, would have brought $1.4 billion into the state, and that money has now gone to California, New York and Massachusetts because they expanded their Medicaid programs.

“Obviously, enhanced coverage would help a lot of hospitals,” Becker said. “The other statistic that blew me away was we have more people per capita on minimum wage, which would definitely benefit from expansion or enhanced coverage going forward … Our survey showed that right now, there are 500 Tennesseans who would like to get into a treatment program and they can’t because there aren’t enough treatment programs to get into … there’s just not enough services to do it.”

Opposition to Medicaid expansion in Tennessee boiled down to hate for former President Obama, said Becker. “Nobody liked Obama. Obviously, we saw it in the election results,” Becker noted.

When asked for THA’s assessment of how Ballad Health is doing, Becker responded: “I think they’re doing really good from what I’ve seen. When you start putting two cultures (Wellmont Health System and Mountain States Health Alliance) together like this … it’s been war here for years between those two systems. It’s going to make more sense out of services and eliminate duplication of services which is huge.”