Tennessee’s Healthcare System: Forced Into a Corner 

Imagine the predicament on Tuesday of Wendy Long, director of Health Care Finance and Administration for the state of Tennessee, as well as, crucially, director of the state's TennCare program, Tennessee's version of Medicaid. Long, also a physician, was the scheduled luncheon speaker of the Rotary Club of Memphis at the Universitry Club, and, if she was late in taking her seat, it was, she would explain, because she was tuned into various news sources to get the latest news coming from Capitol Hill in Washington.

As it happened, Tuesday was also the day that Mitch McConnell (R-KY), majority leader of the U.S. Senate, had indicated he would require a vote in that august deliberative body relative to pending legislation regarding a possible repeal of the Affordable Care Act (aka Obamacare) and/or a possible replacement measure to govern the nation's national health-care policy.

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If that has a vague sound to it, it's because McConnell's intentions were indeed vague, as would be whatever mechanism he trotted forth for the unsuspecting Senators to deal with. McConnell's legislative gambit on health care this week was even more a mystery than the one he laid before the Senate two weeks ago after clearing it in advance with only 12 fellow Republicans, members of an ad hoc committee appointed by the Majority Leader.

That bill, which polls showed only 11 percent of the nation's population favoring, would have ultimately knocked some 22 percent of current insured Americans out of coverage. The bill got nowhere, as a fair number of Senate Republicans refused to go lock-step with it. (Democrats were universally opposed to both it and any other arbitrary measure repealing the A.C.A.)

On Tuesday, no one knew what McConnell had in mind at the time of Long's scheduled Rotary appearance in Memphis. It was thought that he might seek a vote merely to forward in discussion of an as-yet-unknown health-care measure, or perhaps he had a specific bill in mind to seek a vote for, or ...

Long had to wing it in her luncheon remarks, although she made it clear that any of several possible directions that the Senate (and later the whole Congress) might take on health care were crucial to Tennessee's medical future — and especially to TennCare, a jointly funded federal/state program that administers to fully 50 percent of the state's population, including, as she put it, "pregnant women, children, parents of children, the elderly, and the disabled." Several of the pending Congressional possibilities under consideration by the GOP-dominated Congress — including a bill already passed by the House of Representatives and whatever has thus far been proposed in the Senate — would effectively either scuttle Medicaid at some point in the not-too-far-off future or impose unsustainable costs on Tennessee's TennCare version.

Asked what outcome her department sought from Tennessee Republican Senators Lamar Alexander (one of McConnell's erstwhile ad hoc group) and Bob Corker, Long answered: "Flexibilty," (a word with numerous implications under the circumstances, some of them ironic). In her competent, detailed way, she had managed to suggest that otherwise the state — and its large population dependent on TennCare  — would shortly be forced into a corner.


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