One in 12 Tennesseans are insured through the Affordable Care Act, which offers reduced-cost private insurance plans. That's 555,000 Tennesseans who don't qualify for TennCare or Medicare, aren't insured through their work, and can't afford traditional insurance.
On the campaign trail a few weeks ago, House Speaker Mike Johnson said that if Donald Trump won a second term and Republicans kept the House, there would be "no Obamacare." That's the ACA.
Trump ran for president in 2016 promising to repeal the ACA, which at that point covered 13 million Americans. He had no plan to replace it. He wasn't focused on the ends. He didn't like the means: another federal safety net program, nicknamed after a man he dislikes.
Trump tried and failed to repeal the ACA, but stripping people of their health insurance turned out to be politically unpopular. Now, apparently, the ACA is back in the crosshairs.
Even if the ACA survives Trump's second term, a 2022 subsidy to the ACA probably won't. The subsidy has made premiums more affordable and boosted enrollment to more than 21 million. If Congress lets the subsidy expire near year rather than renewing it, premiums are projected to rise by an average of 79 percent, and the number of Tennesseans without health insurance is projected to rise by 39 percent.
I suspect Congress will ignore the ends and focus only on the means: it's Biden's subsidy, and it uses federal dollars. If they eliminate it, mission accomplished.
But is that good governance?
Recently I was discussing health insurance with a woman who does medical coding here in Chattanooga. She told me she regularly sees cases where uninsured diabetics have amputations that could have been prevented with proper disease management. They can't afford to go to the doctor, so they put off going until they're miserable. Then it's too late.
Tennessee already has high rates of diabetes and other chronic diseases. That's about to get worse. It also has sky-high rates of household medical debt and bankruptcy. Those are about to get worse too.
Many of us have seen or felt the ripple effects of medical debt. I watched it bankrupt a family I care about. They lost their small business, their house, and their credit. They never recovered.
Even if we aren't affected personally, we all lose when many Tennesseans can't afford to go to the doctor or pay their medical bills. That's how we get overcrowded ERs and shuttered county hospitals and higher insurance rates.
Governor Bill Haslam understood the economic reasons for getting more Tennesseans insured. He tried to get our state legislature to accept the federal funds to expand Medicaid (TennCare). They wouldn't do it then and they still won't, apparently for ideological reasons.
Forty state governments now accept those annual Medicaid funds, but Tennessee has deliberately left more than $22 billion -- our own federal tax dollars -- on the table.
I've never seen elected officials so dedicated to denying us access to health care, and so disinterested in giving us what we paid for. (With public servants like these, who needs insurance adjusters?) While they're running interference between us and the health insurance that we've paid for with our taxes, they're receiving health insurance that we paid for with our taxes. I guess their ideology doesn't extend to themselves.
I'm reminded of another conversation I had, this one with a woman who studies public health systems across the country.
She told me that the Cherokee Nation in northeastern Oklahoma is building a network of health centers so nobody in that fourteen-county area has to drive more than thirty minutes to get to the doctor. The tribal government is cobbling together funding from Indian Health Services, Medicare, Medicaid, and private insurance, and covering the last dollar itself. It's partnered with various providers, as well as the VA, to give every resident access to pharmacy and optometry services, diabetes education, behavioral health services, veteran services, and medical specialists.
Imagine elected officials who won't play politics with health care, who'll give us a full return on our tax dollars, and who are focused only on using those tax dollars to improve our lives.