Oak Ridge forum: Medicaid expansion could boost state economy

Improving Tennesseans’ overall health would enhance the state’s wealth.

That was one of the messages from panelists at a recent forum sponsored by the League of Women Voters of Oak Ridge and other organizations on the need for Medicaid expansion in the state. The forum was held at Oak Ridge Associated Universities' Pollard Auditorium. The panel members argued that expanding Medicaid in Tennessee for more than 300,000 uninsured, low-income residents would not only improve their health and ability to work and pay taxes, but also enable some closed rural hospitals to reopen, creating jobs, attracting businesses and retirees to these areas and boosting the state’s economy.

“Tennessee leads the nation in per capita hospital closures,” said Judy Roitman, executive director of the Tennessee Health Care Campaign. She added that “22 out of 95 Tennessee counties do not have a hospital and 19 counties do not have an emergency department. Tennessee is 10th in the nation for medical debt.”

“There’s no credible economic reason to not expand Medicaid,” said Matthew Harris, a University of Tennessee professor of economics with a specialty in health care. An economist with the Boyd Center for Business and Economic Research in the Haslam College of Business in Knoxville, he pointed out that while Tennessee is one of the Top 10 states for economic growth, it is also one of the bottom 10 states for health.

“By Medicaid expansion we mean the part of the Affordable Care Act that raises eligibility for Medicaid to all individuals who live in households earning an income up to 138% of the federal poverty level,” said the forum moderator Zack Buck, a UTK assistant professor of law and bioethics. “This is currently about $19,000 for a household annual income for an individual who lives alone or about $38,000 a year for a family of four.”

More than half (57%) of the Tennesseans trapped in the coverage gap hold jobs, and 40% worked for pay in the past five years.

Buck noted that seven states have expanded Medicaid recently because of successful ballot initiatives. Voters have brought Medicaid expansion to Missouri, Oklahoma, Nebraska, Utah, Idaho, Maine and most recently, South Dakota.

Judging from the experiences of the 39 states that have expanded Medicaid since 2014, Harris added, “There are no negative economic consequences for Tennessee to expand Medicaid.” He stated that expansion would increase the number of jobs, including those for health care professionals, and boost earnings in the state by $1.5 billion.

The Tennessee General Assembly is rejecting not only $1.4 billion of federal tax dollars for Medicaid expansion but also a signing bonus of $900 million over two years from the American Rescue Plan of 2021. According to the Tennessee Justice Center, “Medicaid expansion would yield a net gain in our state’s economy by supporting 15,000 new jobs and making Tennesseans healthier on average.”

“The state budget will increase by $1.58 for every dollar that it spends on Medicaid health insurance,” Harris said. “That’s a positive return on investment for the state budget.”

TennCare, which is operating under a controversial block grant approved by the Trump administration, is the state’s Medicaid program. It covers 21% of Tennessee adults and 50% of the state’s children. It provides healthcare to mostly low-income pregnant women, caretakers of a minor child, children and individuals who are elderly or have a disability.

Dr. William Culbert, a retired physician from Oak Ridge, gave several reasons why increasing health insurance coverage for Tennesseans is economically beneficial.

“We have 26 million people in this country that don’t have health insurance,” he said. “That’s led to a lot of health disparity. For instance, if you have good health insurance and you live in a large city, you can get the best cancer treatment in the world. But we still have several tens of thousands of Americans that die every year from the simplest preventable conditions like a urinary tract infection or a splinter in a finger.”

The reason, he added, is that they cannot afford visits to a physician, so they wait until their health condition gets so serious that they must go to a hospital’s emergency room.

“If you don’t diagnose hypertension, diabetes or lung cancer in the early stages, those problems become very expensive conditions that we all pay for as people get older and get into Medicare,” the doctor said. “For instance, hypertension (which causes heart attacks and strokes) is now the leading cause of death in the world. In the United States, 54% of our residents who have high blood pressure are undiagnosed, untreated or undertreated. That’s up from 44% ten years ago. Similarly, diabetes and its early condition, called metabolic syndrome, affects one-third of the adult population in the United States.”

If hypertension and diabetes are diagnosed early, Dr. Culbert said, they can be treated with an inexpensive drug called an ACE inhibitor costing $15 a month. But if people having these conditions wait too long, they could end up on dialysis because their kidneys can no longer purify their blood. “Dialysis costs $90,000 a year and you’re tethered to the machine for four hours a day and three to four days a week for life. It’s all preventable.”

He added that lung cancer can be diagnosed early in people who smoke 20 packs of cigarettes a year by having them undergo low-dose CT chest screening.

Dr. Culbert cited objections to Medicaid expansion raised by Tennessee legislators. He said some call it a big government entitlement program that will take away the state’s freedom to administer Medicaid the way it knows best. Furthermore, some lawmakers claim that the uninsured people are lazy.

The doctor said that Medicaid is now well-managed and that “when Ohio, one of the biggest expansion states, began to cover 700,000 uninsured, they found that the new Medicaid recipients had higher rates of job seeking activity than the general public. So, expansion doesn’t lead to indolence, it leads to industry.”

He urged the forum audience to be strong advocates for Medicare expansion because

“our legislators are hearing from the big-moneyed corporations that want to maintain the status quo. They do that at the expense of all of us. Medicaid expansion in Tennessee, along with the changes taking place with Medicare, will act as a lynchpin to improve the efficiency, effectiveness and the equity of everyone’s health care regardless of the type of insurance they have, and it will ultimately save us all a fortune.”

Roitman said that 7-9% of the populations in Knox, Roane, and Blount counties are uninsured and 9-11% of the residents of Anderson and Morgan counties lack health insurance. Many hospitals, including those in Oak Ridge and Maryville, “are drowning under the weight of uncompensated care.” As a result of the rural hospital closures, county ambulances have become emergency rooms, she said, adding, “Do you know how it feels to watch someone die in the ambulance when all you know is CPR and how to apply a tourniquet?”

The cost of not expanding Medicaid, she explained, has caused high levels of anxiety among parents, school nurses and physicians in rural areas lacking hospitals and emergency rooms. They worry about children with severe allergies and seizure disorders who may need immediate care and the necessity of having to send patients an hour’s drive away to get an X-ray or other lab tests.

In an answer to a question, Roitman said that when Kentucky expanded Medicaid, there was a 700% increase in the number of people seeking opioid treatment. Dr. Culbert said that statistics on states that have expanded Medicare indicate a 6% decline in the mortality rate, a 5% decrease in criminality and a 7-10% reduction in hospital admissions for opioid overdoses and mental health issues.

Rev. Derrick Hammond, pastor at Oak Valley Baptist Church and member of the Oak Ridge City Council, talked about the health care disparities affecting Black Americans and other minority and marginalized communities, made worse for Tennesseans because of the failure to expand Medicaid.

He highlighted unequal medical care for Blacks, some of which is caused by the enduring but incorrect perception by many white physicians that “Black patients’ pain is less severe than that of white patients, so they are given less appropriate treatment.” He called this an example of structural racism, along with past enslavement of African-Americans, racialized residential segregation (redlining, which greatly reduced generational wealth) and law enforcement and criminal justice inequities, such as police violence against and mass incarceration of Black men.

He mentioned that minority communities have a higher rate of maternal and infant mortality, as well as cases of cancer, tuberculosis and maternal postpartum depression and other “psychosocial stressors” that often go untreated. Hammond added that many Blacks forced to live in racially segregated residential areas have health issues caused by exposure to environmental toxins from nearby factories and fossil fuel power plants.

Not expanding Medicaid to cover a broader segment of society makes no sense, he said, suggesting that racism embedded in the state’s social policies could be one reason why state lawmakers have rejected Medicaid expansion.

Hammond said he believes that change will come only if “something happens to shock the white conscience,” like the brutal death of George Floyd by policemen, or if there is “a mass movement.” He gave the example of the American criminal justice system that imprisoned many Blacks for use of crack cocaine and other illegal drugs. This century the justice system pivoted to a different point of view: the opioid drug addictions in white communities are often perceived not as crimes but as health problems needing medication-assisted therapy – another argument for why Medicaid should be expanded in Tennessee.

Photos of the panel, J

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