Health care is top of mind for all Americans, and it’s an issue many are voting on. Recent Democratic victories in Kentucky and Virginia gubernatorial elections reflect the overwhelming popularity of Medicaid expansion and protections for people with pre-existing conditions.
Americans want expanded access to quality and affordable health care without stipulations and excessive restrictions. But certain states are continuing to pursue dangerous Medicaid experiments that would limit health care access. The latest state to seek federal approval for such an experiment is Tennessee.
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Gov. Bill Lee (R) and his state are moving forward with a Medicaid waiver proposal that threatens care for 1.4 million of the state’s most vulnerable residents, including children and people with disabilities. The proposal, currently pending with the U.S. Centers for Medicare and Medicaid Services, seeks to convert the state’s Medicaid program — TennCare — into a block grant.
This block grant would allow the state to receive a large block of federal funding — about $8 billion — along with flexibility to make decisions on how to spend it. In a nutshell, if approved, the change would incentivize cuts to both enrollment and benefits.
It would lead to coverage reductions and establish barriers to accessing health services, especially as the state could keep half of the money it generates in savings from the program and exercise the discretion to spend it elsewhere. Enrollees, meanwhile, would see reduced access and quality of care, including fewer covered providers and medicines and less comprehensive health services — this in a state that saw one of the largest spikes in the rate of uninsured in the country and where 1 in 10 residents are uninsured. While Tennesseans need increased access to care, this block grant proposal would simply do the opposite, giving the state the ability to shift funds to alternate budgets, cutting benefits and slowing down enrollment.
In its news coverage surrounding the grant, The Tennessean recounts the stories of Tennessee residents like 6-year-old Abel and 6-year‐old Harrison. Abel is a cancer survivor whose chemotherapy treatment was paid for by TennCare, and Harrison has autism and depends on TennCare for coverage.
Both boys, along with hundreds of thousands of other children and adults with similar conditions, could see decreases in their care. After all, putting a cap on care really only hurts those who need it most.
Earlier this fall, Tennessee opened this proposal up for public comment, and Tennesseans made their voices heard. The proposal received more than 1,800 public comments, serving as a testament to Medicaid’s popularity. Although the state made some adjustments before sending its waiver application to CMS for approval, these changes were insufficient to ensure TennCare enrollees won’t see a significant decrease in coverage.
Medicaid block grants in various forms have long been pursued by Republican policymakers. Tennessee’s waiver, if approved, will undoubtedly open the flood gates for more such proposals from states across the country.
This would be unprecedented and highly detrimental to not only vulnerable Tennesseans but also millions of other Americans across the country who may see their health care put in jeopardy. On the other hand, given lessons from the Kentucky and Virginia elections, limiting Medicaid may also put Lee and his administration in jeopardy when Tennesseans show up at the polls.
The long-standing intent of Medicaid is to ensure that quality health care coverage is accessible for those most vulnerable. Dangerous experiments such as Tennessee’s run directly counter to that intent.
Consumers for Quality Care urges CMS to reject Tennessee’s block grant waiver application and any others that may follow. We encourage governors to listen to their constituents and expand Medicaid — or risk suffering big losses in upcoming elections.
Donna M. Christensen is a member of the Consumers for Quality Care board, and she retired from the U.S. House of Representatives in 2015, where she served nine terms and was the first female physician to serve as a member in the history of the U.S. Congress.
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