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VOL. 42 | NO. 39 | Friday, September 28, 2018

Leaders ignore calls to drop out of Obamacare lawsuit

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A Christian group pleading with Tennessee leaders to drop out of a lawsuit seeking to overturn the Affordable Care Act could be compared to a tree falling in the forest.

If nobody’s listening, what chance do they have of being heard?

So far, their pleas for coverage of pre-existing conditions – an Obamacare hallmark – are falling on deaf ears.

Members of the Southern Christian Coalition say they met recently with representatives of Tennessee Attorney General Herbert Slatery but didn’t believe they were heard. Feeling slighted, they took to the Legislative Plaza in front of Slatery’s Nashville office in the War Memorial Building, once again asking him to withdraw Tennessee from the lawsuit Texas vs. Health and Human Services.

“Pre-existing-conditions clauses were especially important to the creation of the ACA,” says Kendra Doty, a Franklin mother whose two middle school sons suffer from food allergies and other illnesses, severely limiting what they can eat. They have insurance now, but she’s afraid a rollback of the Affordable Care Act will put them at risk if her husband’s insurance changes and especially once they’re too old to be on parent coverage.

Standing near the monument to soldiers who died in World War I, Doty breaks up when she describes hearing one of her sons wonder, “Why did God make me like this?”

But despite their physical problems, she can’t help but think they are perfect ­– made in God’s image – and deserve equal protection under the Constitution.

“As a mother, as a citizen of the state of Tennessee, I struggle to comprehend how is it we can teach our children that all men are created equal and then sign on to lawsuits that are specifically aimed to remove protections that currently prevent health care insurers from discriminating against our citizens, against children, simply on the basis of their God-given pre-existing conditions?” Doty says, fighting back tears.

United Methodist Church deaconess Sophia Agtrap grows emotional, too, when talking about the matter, saying she can’t sit idly while 2.7 million Tennesseans with pre-existing conditions are placed “in danger” by the state’s effort to kill the ACA.

“And we believe it is a joint responsibility between public and private because God created all of us to thrive and be well and be whole, not to suffer because of political machinations and partisan politics,” Agtrap says. “We are here today and will continue to show up and to fight for the right to live and to thrive. This issue is not some theoretical debate, attorney general, but is a very political one and a personal one.”

Agtrap becomes even more upset when she talks about her mother, a public health nurse in a federally-funded clinic in Guam who is nearing retirement but won’t consider moving to Tennessee because she’s afraid she won’t be able to find health insurance coverage as a cancer survivor of nearly 20 years.

“What type of environment are we creating when folks have to make these choices or don’t have any choice at all but to wait to die?” she asks.

The group is determined to continue showing up. But the attorney general apparently isn’t listening, at least as far as we can tell.

Where is the AG?

Because the case is pending, Slatery’s office has nothing to say beyond a Feb. 26 news release when it joined several states asking a federal district court in Texas to hold the Affordable Care Act unconstitutional and to “enjoin” the entire law.

Slatery’s statement explains the U.S. Supreme Court narrowly upheld the main provision of the act in 2012, the individual mandate, when handling NFIB v. Sebelius, viewing the penalty for not getting insurance as a “tax.”

“But now, with the recent passage of its tax reform package – the Tax Cuts and Jobs Act of 2017 – Congress has repealed this tax, while leaving the mandate in place. Since the Supreme Court has already held that Congress has no authority to impose the individual mandate on Americans without invoking its taxing authority, the repeal of the tax renders the individual mandate unconstitutional. And, since the ACA is dependent on the individual mandate, the ACA itself is now unconstitutional,” Slatery says in the statement.

Tennessee is forging ahead, too, with about 20 other states that argued in a Texas court last week in favor of dismantling the act. Their lawsuit is being countered by the state of Maryland, which filed its own lawsuit recently against President Donald Trump’s administration, accusing him of trying to undermine the law.

Maryland contends more than 100,000 of its residents have gotten private health coverage since the law took effect, and the cost of uncompensated care has plummeted by about $300 million, according to a Baltimore Sun article. Maryland got federal approval to set up a health reinsurance program designed to protect insurance companies from increases in claims and keep rates down in the individual market of the state exchange.

Where they stand

Slatery’s move to put Tennessee in the lawsuit contradicts the Insure Tennessee proposal by Gov. Bill Haslam three years ago to expand Medicaid here through a market-based program sanctioned by the federal government to catch 290,000 people in a coverage gap. Haslam came up with the idea, which never made it to the House or Senate floor, after the Legislature opted to keep Tennessee out of the federal exchange. Tennesseans can get coverage under the Affordable Care Act, just not through a state program.

State Rep. Raumesh Akbari, a Memphis Democrat seeking a Senate seat this fall, says the state’s decision to join the lawsuit wasn’t needed. Because of the health care law, thousands of Tennesseans are able to get health insurance coverage they didn’t have before, especially those with pre-existing conditions and many women, Akbari points out.

“It’s completely unnecessary, and I wish we would have abstained from joining that lawsuit,” Akbari says.

Democratic gubernatorial candidate Karl Dean is a staunch supporter of expanding Medicaid. He says it’s crucial from a health care standpoint and economically, since 11 rural hospitals across the state employing large numbers of people have closed in the last few years.

Dean says Tennessee has lost more than $4 billion in funding that has gone to 37 states that expanded Medicaid and he’s run TV ads highlighting the difference between himself and Republican candidate Bill Lee on the subject.

Lee, like most Tennessee Republican officials, opposes Medicaid expansion under the Affordable Care Act, saying it’s “an unsustainable program, a federal spending program that will … continue escalating costs and ultimately (cause) an unstable environment.” He says he wants to bring doctors, patients, providers, universities and research centers together to “provide care in a cost-effective way,” reforming a “fundamentally flawed” system and lowering costs.

U.S. Senate candidates, Republican U.S. Rep. Marsha Blackburn and former Democratic Gov. Phil Bredesen are on different wavelengths, too.

Blackburn, along with President Trump, wants to repeal Obamacare. She touted it as one of her priorities when she announced her candidacy.

Bredesen, on the other hand, recently said he would expand Medicaid and called it a “waste of money” not to take the federal funding that could be flowing back to Tennessee, even though he removed tens of thousands of people from the TennCare rolls during his gubernatorial terms because of escalating costs.

When attacked for backing socialized medicine in a recent advertisement purchased by the super PAC Senate Leadership Fund, Bredesen’s campaign rebutted the notion, saying he wrote a book in response to passage of the Affordable Care Act in which he referred to it as the “mother of all unfunded mandates.”

The campaign’s statement states: “Bredesen argues that health care in America is broken with unsustainable costs and inconsistent quality and provides a hypothetical solution to one of the largest problems facing the United States.”

During a recent forum on opioids, however, Bredesen says even though he was “skeptical” about the Affordable Care Act, now that it’s the law of the land. “Efforts to sabotage are unconscionable and immoral,” he says. “Stabilize it and make it more attractive for people.”

The analysis

No doubt, every candidate would agree health insurance is extremely expensive, in large part because treatment costs are skyrocketing. By the time we pay the medical clinics, the hospitals, the doctors, insurance companies, pharmaceutical companies, pharmacists and all of their consultants, vendors and sales folks, things can get a little pricey. Tamping down the basic cost of a physical would be a good start.

But considering Tennessee didn’t even expand Medicaid in accordance with the Affordable Care Act, Slatery’s decision to try to dismantle it could be called into question. If nobody else, this small but vocal Christian group is taking a stance against the state’s top lawyer, and it doesn’t appear ready to quit.

Meanwhile, Slatery’s office is content to stand by a months-old release on the Affordable Care Act lawsuit but feels it necessary to send out a statement congratulating former Republican gubernatorial candidate Randy Boyd for being nominated as interim president of the University of Tennessee.

“Randy Boyd’s key role in the governor’s signature higher education program, the Tennessee Promise, his familiarity with state government and his campaign experience places him in a unique position to guide the University of Tennessee education system at this pivotal time,” Slatery says. Boyd was expected to be approved Tuesday by the UT Board of Trustees.

What does this have to do with Obamacare? Absolutely nothing. But if Slatery has time to praise Boyd, he could take the opportunity to acknowledge this group of people fighting for the sick.

Sam Stockard is a Nashville-based writer with more than 30 years of experience as a reporter, editor and columnist covering the state Legislature and Tennessee politics for The Daily Memphian.

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