Tennessee Republicans introduce rural healthcare plan

President Ronald Reagan meets Katie Beckett, along with her parents, Julia and Mark Beckett as the president exits Air Force One on the tarmac of Cedar Rapids Municipal Airport, Iowa, 20 September 1984. (photo by official White House photographer Michael Evans, courtesy of the Ronald Reagan Presidential Library)

Tennessee Republican lawmakers have proposed a health care reform package that they say is a “patient-centered, free market approach” to Tennessee healthcare.

Named the CARE plan, ‘Consumerism, Access, Rural, Empowering’ proponents say that the plan is an important first step to offering healthcare solutions that will “increase access and the quality of care available to Tennesseans, while driving down overall costs and protecting all patients whether or not they have preexisting conditions.”

The plan is in response to pressure of the state refusal of Medicaid expansion, what many see as the reason for the closure of so many of the state’s rural hospitals.

“Unlike the legislatures of virtually every other state in the United States, the Republicans who currently control the Tennessee legislature have resolutely refused to expand health care,” said Democratic Caucus Chair Mike Stewart.

According to lawmakers, the plan will create price transparency and more data on healthcare prices, launch an All-Payer Claims Database that will provide consumers with information to contain costs and improve health system performance through the utilization of local data, eliminate confusion and streamline billing, promote competition, improve drug pricing affordability, utilize telehealth and telemedicine to increase rural healthcare access, recruit innovative healthcare professionals, physicians, and biotech companies to our state, assist families in caring for sick children despite their financial status, explore options to increase access to behavioral health services, and secure block grant funding so Tennessee can create a patient centered healthcare system to address our unique needs.

The goal of the initiatives will increase access and the quality of care available to Tennesseans, while driving down overall costs and protecting all patients—with or without preexisting conditions.

“Our healthcare crisis was not created overnight. In fact, this is an issue that has been building in cities and towns across our state over the past two decades,” said Tennessee House Speaker Glen Casada (R-Franklin). “This plan is an important first step in addressing the health concerns of all Tennesseans through increased competition and transparency, and once again, it demonstrates Tennessee’s ability to lead on an important issue with both local and national implications.”

In response to the CARE Plan, Michele Johnson, executive director of Tennessee Justice Center, said: “We are glad our legislators finally heard that healthcare is the number one priority in our state. We want to see the issues we talk about around the kitchen table actually addressed by our legislators.

It’s not clear what their proposal actually does, except for the progress for the small number of families that need the Katie Beckett waiver to help them receive care despite their financial status. The legislators should focus on specific policies to address the healthcare crises in Tennessee. Three hundred thousand working Tennesseans are uninsured, and hospital closures are gutting rural economies. They use a lot of hot-button words, but we want to see them roll up their sleeves and provide real solutions.”

Most of the CARE plan is in a series of bills that will be heard this session.

Katie Beckett Medicaid waiver

The waiver is named for Katie Beckett, a three-year-old who had been hospitalized since infancy so that she could receive ventilator assistance after a viral encephalitis infection left her partially paralyzed in a way that affected her ability to breathe. When her situation came to the attention of the newly elected Reagan administration, then preparing its first budget, the administration seized the story as a way to deregulate and reduce the costs of Medicaid.

In Tennessee, children with disabilities who require an institutional level of care, and who could be safely taken care of at home by their family with assistance, do not qualify for Medicaid if their parent’s income is over the limit set by the state. Medicaid will cover the care for these same children if they are institutionalized. In fact, families cannot keep their children at home, even if it can be proven to be a safe and cost-effective alternative to an institution.

Tennessee is the only state that has not adopted any programs, such as the Katie Beckett Waiver or the Tax Equity and Fiscal Responsibility Act (TEFRA) program, that could help enroll children with severe disabilities in Medicaid and provide them the opportunity to receive home care, regardless of their family’s income. Rather, Tennessee’s Medicaid program (TennCare) has financial criteria that deem a lot of children with severe disabilities to be ineligible for Medicaid because of their household income. The state is forcing families to face financial ruin to care for children at home or institutionalize them so that Medicaid pays for the care, often at a higher cost.

The Katie Beckett Waiver would provide health insurance to children and adolescents with disabilities who don’t currently qualify for Medicaid because of their parent’s income. The Katie Beckett Waiver would allow states to give Medicaid to children with disabilities as a way of preventing their placement in an institution, even if their parents earn too much for them to qualify. Similarly, the TEFRA program provides Medicaid coverage to children with severe disabilities younger than 19 who require an institutional level of care, without using their family income as an eligibility criterion. The TEFRA program would benefit children who receive extended care in an institution and would make the eligibility determination based solely on the child’s income.