Monday, July 7, 2014

Let's Stop Kidding Ourselves About the So-Called 'Tennessee Plan'

Posted By on Mon, Jul 7, 2014 at 8:08 AM

Over at the Tennessean, Tom Wilemon has the heartbreaking story of Larry and Linda Drain, a married couple who have separated in order to keep Linda insured:

Six months into the full implementation of the Affordable Care Act, the Drains are among 162,000 Tennesseans who got caught in a coverage gap. Their household income is too little to qualify for a government subsidy to buy health insurance, and they live in a state not expanding Medicaid.

Linda has a series of health problems which means that not having insurance would be devastating for her. Larry's not in the best of shape, either. You'd think, as big as we are into protecting the sanctity of marriage, that this would be disturbing to folks, but I guess not.

Here's the other upsetting part:

Behind the scenes, officials within the Haslam administration have been talking with federal officials about how Tennessee might qualify for Affordable Care Act federal funds to cover poor, uninsured people. But the governor ruled out expanding Medicaid in March 2013 and said he favored a plan to leverage federal funds to, instead, help the poor buy private health insurance. Haslam said then that a "Tennessee Plan" should require copayments so people would have "some skin in the game."

"Governor Haslam believes that more people having access to health care is a good thing, but you have to do it in a way that controls costs and provides for better outcomes," said Dave Smith, press secretary for Haslam. "The governor and administration continue to have discussions with HHS and CMS about the Tennessee Plan, the governor's approach for a third path to real health-care reform for Tennessee."

I would give a hundred dollars to see Bill Haslam, or hell, even Dave Smith, stand in front of the Drains and tell them to their faces that they don't have skin in the game. Just how high must your gilded tower have to be to think that sick poor people need to be forced to be committed to their own health? The governor should spend a day with the people from Remote Area Medical when they are treating Tennesseans, get some skin in the game himself. People wait in line for hours to see doctors and Haslam somehow still feels justified in acting like they're slackers who just won't take care of themselves unless forced.

But here's the other thing, and I say this lovingly to all my media brothers and sisters, we need to stop bullshitting people about "The Tennessee Plan." If there is a plan, we should be able to read it. Why do we continue to let Haslam's administration say there's a "Tennessee Plan" without anyone actually having laid eyes on it?

If I say that I have plans to build a bridge across the Cumberland, is the only question a reporter asks me, a person with no bridge-building experience, no property along the Cumberland, and no meetings lined up with the Army Corps of Engineers, really going to be "Where?" Or might someone ask "How?" and "Can we see the literal plans for said bridge?"

Every bill the state legislature is thinking about passing is posted for everyone to see. Our U.S. congressional delegation, at least the ones I've had dealings with, have been very happy to share the actual bills they're working on. If there's a real Tennessee Plan, why can't we see it? This is what there is: a press release with a YouTube video and a PDF called "Tennessee's Plan for Health Care Reform." The PDF is just a copy of the remarks he gave to the state legislature.

Again, to go back to my bridge-building analogy, if you asked to see how high I'm planning to build my bridge and what kinds of footings I'll use to support it, you wouldn't be satisfied if I sent you a YouTube video that just re-announced my "plan" to build a bridge across the Cumberland. You'd start to suspect that I just have a dream of building a bridge across the Cumberland, but no real idea of how to make it happen.

As far as I can tell, and Sweet Jesus, I'd love to be wrong about this — that's what we have here: a dream with no actionable concrete plan. The Governor announced that he had a plan back in March of 2013. He announced all the things the plan would do (and notice all the "would"s in order to give the impression that there's an item with complex language in it that can be distilled down to a simple "would" sentence) and then never shared with the public the plan. Every instance I can find of a reference to the plan refers not to the actual plan but to the announcement of said plan.

Paige Huntoon over at MetroPulse in Knoxville had a good story last year about why the actual contents of the Tennessee Plan seem so hard to nail down — "The details of this plan were vague and extremely broad because they hinge on making a deal with HHS." In other words, there is no concrete Tennessee Plan, in part, because Haslam needs to see what HHS will let him do.

Right now, the copay issue is amorphous, relegated to only people who "can" pay, whatever that might mean. Putting down real terms would mean, as Huntoon's piece explains, having a measurable distance between what Haslam thinks people "can" pay and what Medicaid allows. Same with the dream of expanding private insurance to people. That sounds great until there's a real number attached and then people can see the differences between what poor people might pay for private insurance in our state and what they're paying to buy in to Medicaid in other states. Right now, the state can blame HHS for not agreeing to the Tennessee Plan, but, if there were a real plan, we'd be able to see what points were under contention. Again, to go back to the bridge metaphor, if I want to build the bridge ninety inches off the surface of the river and the Corps wants it to be ninety feet in the air, we could argue about the actual necessary height of the bridge. But if I never tell you how high I want my bridge to be, I can blame the Corps for the lack of progress on my bridge.

As long as it's vague, it's hard to criticize. But if you believe there's a real Tennessee plan in the way you or I would expect a plan to look, I have a bridge over the Cumberland to sell you.

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