As much as any other issue impinging on the fortunes of Tennessee is the imminent prospect of federal block grants to pay for the state's Medicaid expenses. The Trump administration has indicated it intends to shift in the direction of block grants, and Republicans in Tennessee, from the time of former Lt. Governor Ron Ramsey, have invoked a preference for the principle as their excuse for not committing to expansion funds under the Affordable Care Act (Obamacare).
The idea behind block grants is simple enough: Monies are dispatched from Washington not in accord with federally prescribed requirements and formulas for distribution but more or less for the states to dispose of as they see fit.
In his State of the State address Monday night, GOP Governor Bill Lee boasted that "with the encouragement of this legislature, I'm proud that Tennessee was the first state in America to apply for a Medicaid block grant from the federal government." He went on: "While we do not yet know whether this proposal will be accepted, I am confident that what we've proposed would be a good deal for Tennesseans and that no Tennessean would be worse off if it is approved."
- Jackson Baker
- Accepting the mic (and an endorsement) from County Mayor Harris, Jerri Green addresses Democrats in East Memphis.
State Senator Jeff Yarbro of Nashville, presenting the Democrats' response, professed himself "disappointed tonight to see the governor mentioning this ill-fated attempt at a block grant. ... It looks pretty clear from what the federal government said last week that it's not gonna come out well for us."
The fact that allows for such disparate views is real enough. The federal guidelines released last week aim in a wholly different direction than does TennCare, the state health-care program that is the primary recipient in Tennessee of Medicaid funding.
The Trump administration's formula, under what is to be called "the Healthy Adult Opportunity Program," limits its assistance basically to that part of the state population that has least need of drastic remedies. The idea is to free up more of a given state's existing health-care resources for more serious problems — like the low-income patients and people with disabilities that TennCare deals with. And it is these people, along with pregnant women and children, who would be the direct recipients of federal block grant assistance under the state's application for a block grant.
Much remains to be worked out if block grants become the primary medium of federal assistance, and undoubtedly some form of accommodation can be arrived at between the state's and the Trump administration's goals. But the unspoken feature of block grants in either formulation is that they provide possible loopholes for ad-libbed, unstructured use of the monies involved.
Meanwhile, Democrats campaigning for legislative office in Tennessee tend to make a major issue of the state GOP's disinclination so far to claim direct Medicaid aid available under the A.C.A. One such is Jerri Green, who, using the slogan "One Tough Mother," is campaigning to unseat Republican state Representative Mark White in state House District 83.
Green has been endorsed by Shelby County Mayor Lee Harris, who introduced her to a tightly packed crowd of 100-odd attendees at Craft Republic in East Memphis last Thursday night. Both Green and Harris pointed out the $1 billion or so in annual federal Medicaid funding that has gone wanting, as well as the inexact fit for Tennessee of the new Trump guidelines for block grants. It remains to be seen if the issue has legs.