Even though Nashville in the healthcare mecca of the nation, Tennessee's health care system ranks in the lower tier of access to care, quality of care and public health. According to US News and World Report, our state ranks:
- Access to health care - #38
- Quality of health care - #31
- Public health - #43
Our Medicaid program (TennCare) is made up of $12 billion in state and federal funding, roughly 1/3 of the state's budget. I have served on the Health Committee for over 7 years and currently sit on the Insurance Committee. Both committees oversee the TennCare program and all healthcare policy for the state.
There are several issues impacting our state's healthcare system that I believe could be managed better or differently. Sitting on the Health and Insurance committees has afforded me the opportunity to see firsthand how policies related to health and insurance can impact families as well as the economy.
If there is an issue I have not addressed below, please email me with your questions or concerns at darren@darrenjernigan.com and I will do my best to address them.
Expanding Medicaid (TennCare)
In 2014 the legislature voted to take away the right for the Governor to expand Medicaid without legislative approval. I voted against this because it was an unnecessary process to block expansion. The Governor then put forth Insure Tennessee, a conservative approach to expanding Medicaid. I voted in favor of this legislation, but the conservative majority voted against the program.
What did they vote against? $1.4 billion in federal funding each year. That's nearly $4 million a day. The Affordable Care Act (ACA), commonly known as ObamaCare, funds 90% of the expansion while the state covers 10%. The Tennessee Hospital Association stepped up pledging the association would cover the 10% each year. The State of Tennessee would pay nothing. Better yet, the state could leave the program anytime with no penalties.
Voting against expansion also votes against 300,000 Tennesseans currently without healthcare. Who are they? Tennessee citizens that make too much money for traditional TennCare and not enough money to qualify for the ACA. These are the folks working two jobs at low wages to make ends meet who are left with no healthcare coverage. Medicaid expansion would single handily transform the healthcare landscape in Tennessee. Further, COVID-19 has increased the need for Medicaid expansion now. Not only have the unemployed lost their jobs, they have lost their access to health care coverage as well.
Not passing Medicaid expansion is not just about a lack of coverage to our low-income citizens. According to a recent study in Forbes (Feb 2020), the non-expansion of Medicaid is the key indicator for rural hospital closures. Since 2010 rural hospital closures in Tennessee ranks number two in the nation behind Texas at 12 closures across the state.
A Medicaid Block Grant program was introduced and easily passed the General Assembly in 2019. I voted against this legislation because the formula would weaken federal protections for the most vulnerable in our state. It was the first of its kind in the nation that would abandon the Medicaid reimbursement formula and let Tennessee spend the federal healthcare dollars at the state's discretion. The proposed plan was so radical that when the Trump administration came out with their own Medicaid block grant waiver, it gutted nearly every provision of Tennessee's block grant application.
Last, I am proud co-sponsor of HB1430 authorizing the governor to expand Medicaid pursuant to the Affordable Care Act. The legislation also authorizes the governor to negotiate with the Centers for Medicare and Medicaid Services (CMS) to determine the terms of the expansion.
The time for expansion is now and I will continue to fight for to expand the program.
Medical Marijuana
Laws supporting medical marijuana in Tennessee are non-existent. Currently, 33 states and DC have laws allowing medical marijuana. Since being in the state legislature I have co-sponsored every single bill advocating to make marijuana legal for medical purposes. I have met with numerous people and family members of people whose medical conditions could be positively impacted with the use of medical marijuana. I have met heart-broken parents summoning unimaginable strength to care for their child who has constant seizures, cancer patients whose recovery could be sped up without debilitating pain that could easily be relieved with the use of appropriately prescribed medical marijuana; the stories are innumerable and the strength of people is both heart breaking and inspiring. I will continue to do everything I can to see medical marijuana become law.
The THC in marijuana can increase appetite and reduce nausea in cancer patients, decrease pain and inflammation for chronic aches, decrease muscle control problems for those with neuromuscular diseases, and reduce anxiety for those with post-traumatic stress syndromes. In the history of the world not one person has overdosed on marijuana, there is no reason not to pass laws that will make medical marijuana legal with proper supervision by a physician. I have never understood how people can accept that doctors prescribe opioids addicting and killing Tennesseans at a rate of three overdoses a day, but we cannot get the super majority to understand how beneficial medical marijuana, which is not addictive, can be.
Aside from the obvious revenue it would generate for the state, virtually every single poll conducted in Tennessee has Tennesseans overwhelmingly in favor of legalizing marijuana for medical purposes, ranging from 75% to 88%. The least we can do for our neighbors, loved ones and friends suffering needlessly is to pursue the fight until Tennessee joins the ranks of forward thinking and acting states, making medical marijuana legal and accessible to those in need.
Children
TennCare and CoverKids have seen a decline in enrollment over the past two years coinciding with the overall decline in the percentage of Tennessee children with health care coverage. Children losing coverage are not moving off these two programs and onto private insurance but instead are being left with no health care coverage at all.
TennCare terminated coverage for at least 220,000 children because of alleged problems with paperwork, not because the state determined that the children were no longer eligible. The state has no way of knowing how many of those children remain financially eligible for TennCare or CoverKids. Most children undergoing the redetermination of eligibility should have remained eligible had the state correctly assessed their eligibility and not simply cut them off for administrative inefficiencies.
This is an issue I continue to fight and advocate for from my position on the Health Committee with oversight concerning these two programs. TennCare should reinstate all children who have had their health coverage terminated until it has accurately determined that they do not meet current eligibility requirements. Further, TennCare should also promptly investigate why so many children lost coverage on administrative grounds.
Health Equity
Health equity is achieved when every person, regardless of race, income, education, gender or other demographics has access to the health care system. We must concentrate on eliminating barriers that prevent individuals and communities from accessing health care services and activities, and focus on individuals reaching their full potential.
According to the Centers for Disease Control and Prevention (CDC) health conditions are directly related to the places where people live, learn, work, and play. These social and community aspects of our lives affect a wide range of health risks and outcomes. Improving these conditions is part of the work that needs to be done to achieve health equity. There is a longstanding history of racial bias and inequity in healthcare systems; it is past time to correct this issue.
COVID-19 has hit the African American community particularly hard. There are severe health disparities showing a high percentage of black people diagnosed with, hospitalized with, or dead from COVID-19 compared to the general population. According to the Journal of American Medical Association the black community has been disproportionally disadvantaged.
I am committed to introducing, and or co-sponsoring legislation to level the playing field through the education of disparities in health care facilities and to provide incentives to these facilities for positive results in closing the gaps.
Opioids
Prescriptions for opioids hit its peak in 2012. In 2017, Speaker Beth Harwell appointed me to the Legislative Opioid Task Force to help combat the crises affecting our state. This task force worked to become educated by experts in the field of substance abuse and addictive disorders, health and mental health, and learned of first responders and law enforcement experiences addressing overdoses in our communities. We learned of best practices across the nation and worked to develop a plan applicable to our state. The result of the work of this task force was the passing of Tennessee Together. Tennessee Together brings together resources with community solutions to battle the opioid crisis. We must continue to focus on prevention, treatment and law enforcement working together to slow down this terrible addiction; an addiction that is ten times that of hunger.
While there has been a steady decline in prescriptions in Tennessee, our outcome levels have not declined. Overdoses continue to report at three per day, which is more than daily traffic fatalities. Even with Tennessee Together, Tennessee remains in the top 15 states in drug overdose deaths. We cannot take our focus off this crisis.
Naloxone is a drug that can reverse opioid overdoses in real time, a literal on the scene lifesaver. In 2017, I voted to allow law enforcement to keep NARCAN, a nasal spray of Naloxone, to fight real time overdoses and save lives on the scene. Further, in 2019, I was one of two co-sponsors passing HB 1360, requiring the Commissioner of the Department of Health to study instances when it is appropriate and beneficial to co- prescribe naloxone with an opioid. I will continue to fight for policies to incorporate this life saving prescription into everyday use.
Mental Health
Living with mental illness does not mean a person cannot have independence and the quality of life they desire. I am a member of the Mental Health and Substance Abuse sub-committee where every day I see opportunities in which government can play a pivotal role for those with mental health issues and behavior disorders.
Access to appropriate resources and counseling can reduce common risk factors and can give a person a better chance at securing housing, navigating the criminal justice system, recognizing substance abuse addictions, and obtaining and holding a job. Society needs to get to a place where mental health is treated on the same level as physical health. It is important that we have resources allocated for responding in real time to a crisis event and services that impact prevention, intervention, stabilization and treatment of mental health and behavior disorders. We need to focus on coupling available government services with private sector resources to reduce risk factors, promote best practices, and increase positive outcomes.
Choice
A woman's right to choose is a constitutional right. It should be legal, safe, and rare. However, the General Assembly continues to chip away at this constitutional right in each session trigging unnecessary lawsuits. I have consistently voted to protect this right and as a father of three girls will continue to do so.
We should come together and focus on how to prevent unwanted pregnancies that would result in less abortions in Tennessee. For example, I plan on introducing legislation that will repeal the sex education abstinence only policy that was implemented in 2012 and taught in schools today. This was a short-sighted policy that has set back our young people from learning important facts about birth control and sexually transmitted diseases. I believe these lessons, as well as abstinence should be taught as part of sex education.