Tennessee’s failed experiment with socialized medicine shows how a popular entitlement can be successfully undone.
Democrats are warning Republicans not to repeal Obamacare. ”They will rue the day” they move in that direction, Senate minority leader Chuck Schumer (D., N.Y.) has stated ominously. “It’s a political nightmare for them. They’ll be like the dog that caught the bus.”
Schumer also claimed that’s it impossible to fulfill promises Donald Trump made to repeal the law while keeping parts of it — including the requirement that health coverage be given to people with pre-existing conditions and the provision allowing young adults to stay on their parents’ health plans until age 26 — intact. “There is no way that you can keep those things without keeping [Obamacare],” he said.
The point of Schumer’s scare tactics is to intimidate congressional Republicans into backtracking on repealing almost all of Obamacare by suggesting that the 18 million Americans who have expanded coverage under Medicaid or subsidized insurance will turn on Republicans with a vengeance if the law is so much as touched.
There certainly is room for concern: Many congressional staffers believe that GOP leaders are “sunshine soldiers” in the fight to beat back socialized medicine, there when a photo op is available but gun-shy when it comes to actually acting. The most stalwart anti-Obamacare Republicans are clustered around the House Freedom Caucus and the House Republican Study Committee. This week, the RSC reintroduced a 186-page bill that would repeal Obamacare and replace it with a mix of insurance reforms, reduced mandates for basic policies, expanded Medical Savings Accounts, and federally subsidized risk pools for people with chronic conditions or rare diseases.
Reporters attending the press conference announcing the RSC plan showed little interest in its policy details, but asked a lot of questions about how much political danger Republicans faced in tinkering with Obamacare. To their credit, several Republican RSC members stepped forward and strongly challenged the assertion that Obamacare was some kind of untouchable third rail of American politics. Representatives Phil Roe and Marsha Blackburn both recounted their political experience in winning the battle to scale back TennCare, a spectacularly unsuccessful expansion of government-subsidized health insurance in their home state of Tennessee that almost destroyed the state’s budget a little over a decade ago.
TennCare was created by Democratic governor Ned McWherter, who in 1993 won a waiver from the Clinton administration allowing him to expand his state’s Medicaid program for the poor. “For the first time, we have the chance to provide affordable health coverage for every Tennessean without bankrupting our state,” McWherter boasted back then. His words eventually became as infamous as President Obama’s “If you like your plan, you can keep it.”
McWherter was right that TennCare expanded coverage. The number of state residents getting Medicare nearly doubled in just seven years. Services were expanded, and utilization rates predictably exploded. But the quality of care deteriorated, the waiting times for doctor’s appointments shot up, and fraud became rampant. A 1999 state audit found that TennCare was paying the bills for 14,000 dead people and 16,500 people who lived out of state, and that 20 percent of all enrollees were ineligible for the program. All of this took a huge toll on the state’s finances: Expenditures per TennCare participant rose from $2,803 in 1994 to $6,613 in 2006, and the “curve” of TennCare spending shot up in an arrow pointing toward bankruptcy.
It would behoove Republicans to examine the case of TennCare to learn how a seemingly unassailable entitlement can be rolled back.
In 2003, a new Democratic governor named Phil Bredesen took office on a pledge to clean up the TennCare mess. A businessman who had helped restore Nashville to fiscal health as its mayor, he spent countless hours explaining that TennCare’s uncontrollable costs would soon force cuts to all other essential state services. In 2005, after two years of legal and political trench warfare, Tennessee removed almost 200,000 people from the TennCare rolls and reduced benefits.
For all the opposition Bredesen encountered in implementing reforms, he ultimately won the policy argument. He was almost unopposed in the Democratic primary for reelection in 2006 and won 69 percent of the vote that November against his Republican opponent. The reforms have largely stuck, and the sour taste of the TennCare experiment prompted the state’s legislature to reject a massive expansion of the state’s Medicaid rolls under Obamacare.
#related#Representative Blackburn, who helped lead the fight against TennCare as a state legislator, told me last year that there are valuable political lessons to be learned from the battle. “First, new government programs can be so bad they collapse under their own weight and there is a demand for change,” she said. Second, “You have to have the courage to get past the visible, special-interest opposition to what you are doing and rally as much as you can the invisible majority that is being hurt by the program. . . . If you are patient, speak to people as adults, and remain firm in your convictions, you not only can win, your leadership can turn the result into a policy and political positive.”
No two situations are identical, but it would behoove Republicans to examine the case of TennCare to learn how a seemingly unassailable entitlement can be rolled back with the right mix of savvy and courage.