Two weeks ago, Tennessee revealed its plan of attempting to make history in American healthcare. The Republican-led state is proposing that TennCare, their state Medicaid program, will be funded by a federal block grant, as opposed to the standard Federal Medical Assistance Program, in which the federal state pays a percentage of Medicaid program costs. Tennessee, a state with a significant lower-income population and roughly half of the state’s children depending on Medicaid benefits, chose not to expand Medicaid in 2016 with the Affordable Care Act. This means that the state had the option to include Medicaid eligibility for thousands more uninsured residents, but opted to remain in their current standards. Ultimately, this leaves a large portion of Tennessee’s most vulnerable populations uninsured. Switching Medicaid to a block-grant program, though saving the state a significant amount of spending money, would exclude patients even further and contribute to the growing uninsured population.
There are two major reasons that a block grant would be damaging to the people of Tennessee. The state government of Tennessee, if the block grant should pass, would essentially have full authority to decide how Medicaid funding gets allocated, who receives benefits, and what gets covered. Furthermore, the idea is largely an experiment with no notion as to how successful it will be.
According to the Commonwealth Fund, “Tennessee’s plan would cap federal spending for: currently eligible poor children and adults (including pregnant women); children and adults covered based on disability; and the elderly…spending for newly eligible people, prescription drugs, dually eligible Medicaid-Medicare enrollees, payments to disproportionate-share hospitals and critical access hospitals, and program administration would be exempt from the cap.” All of these groups of people and programs labeled as exempt would be negatively affected by the block grant. The very vulnerable populations that Medicaid was designed to help would be cut from receiving the services they were guaranteed. The Washington Post points out that in fact 1 million of the 1.4 million state residents on TennCare would be impacted.
In addition to the damaging effects that could possibly result from the enactment of a block grant program for Medicaid, this is something that has never been done before. As such, the Commonwealth Fund noted that, “officials cannot estimate its impact on people, federal funding, or the state’s economy.” While there is a potential for this approach to work long term, thousands of residents who deserve healthcare would be hurt in the process. It would be a gamble for something that has not been proven to work in our country’s history. If it does work, and we can figure out a way to deliver the same services we have been delivering while cutting funds, that would be ideal. But in doing so, we would be using vulnerable people with dire health related needs and risking their wellbeing.
The Tennessee government appears to be making an attempt to set an example for other states to follow in reducing Medicaid spending while cutting its benefits, and they do not seem to acknowledge the effect that it will have on the people of Tennessee. Health and wellbeing are at stake for the purpose of economic improvement, and while possibly fiscally productive, it neglects the essence of what matters: the lives of the patients it will impact.
