Nolensville Homepage | Landon Woodroof
Five candidates for governor on Tuesday morning answered a variety of questions related to healthcare policy, services and outcomes in Tennessee.
Much of the conversation dealt with ways to improve Tennessee’s place near the bottom of national rankings of health.
The forum, at Trevecca Nazarene University in Nashville, was sponsored by the Nashville Health Care Council and the Governor’s Foundation for Health & Wellness. Republicans Randy Boyd, Beth Harwell and Bill Lee, and Democrats Karl Dean and Craig Fitzhugh participated in the forum.
Governor’s Foundation President and CEO Rick Johnson laid a foundation for the discussion at the beginning of the program.
“Over the past decade Tennessee has made significant progress in education, jobs creation, economic growth and government effectiveness and efficiency yet according to national rankings the state remains one of the least healthy in the country,” Johnson said. He described how Tennesseans are at a particularly high risk of developing chronic health conditions like cardiovascular disease, asthma and Type 2 Diabetes.
Moderator Hallerin Hilton Hill started off by asking the candidates what their number-one health care priority would be upon assuming office.
Speaker of the State House of Representatives Beth Harwell said it was important for states to get flexibility from the federal government that would allow them to design their own programs that could tackle issues like prevention.
“Truly the states are the laboratories for change,” she said.
Former Nashville Mayor Karl Dean framed his number-one priority a different way.
“The most immediate need is to have more access to health care,” he said, stating that he felt it was a huge mistake for the state to turn down an expansion of Medicaid. He noted that 10 hospitals have closed in Tennessee and hundreds of thousands of Tennesseans are without health insurance.
Randy Boyd, a businessman and former state commissioner of economic and community development, drew attention to opioids.
“First of all we would declare a state of emergency against opioids,” he said. He also said the state should put more resources into mental health issues.
“It’s something we haven’t invested enough in the past four decades and we’re paying a price,” he said.
Businessman Bill Lee highlighted his experience as an employer of 1,200 people. He said it was essential to get payers, providers and patients together to work out a solution to the state’s health care woes.
“My goal would be to bring the competing interests together and put them on the same team,” he said.
State House Minority Leader Craig Fitzhugh stressed health care access, much as Dean had.
“My first priority is to the expansion of Medicaid,” he said. “It will open up so many doors and windows and levels for our health care.”
Subsequent questions grew more specific, dealing with issues like prevention and health care access, the opioid epidemic, and Medicaid work requirements.
Many candidates agreed that prevention was a key part of improving the state’s health care and that the earlier people learned to lead healthy lifestyles the better.
“The way I see it education plays a major role and there should be more education dollars and health dollars going to educating our youth to understand the need to eat healthy and to be healthy, and that includes access to exercise,” Dean said.
Harwell suggested offering incentives to people in an effort to lead them to healthier living. For instance, she drew attention to a recent program that offered lower premiums on state insurance to those who take part in wellness program.
“We’ve taken some first steps but there is so much more that we can do,” she said, including offering healthier lunches at schools.
Boyd cited steps his business had taken to improve outcomes for employees. He said his company has an onsite clinic and offered health and wellness programs to employees. Those features, he said, had helped to lower his company’s health claims by 19 percent last year.
On the question of health care access, Fitzhugh again spoke about the need for a Medicaid expansion. He framed the decision not to expand access in the state as a political one that did not serve citizens well.
“There are 33 other states that have” expanded Medicaid, he said. “It opens so much and gives us much more flexibility in our entire program.”
Lee said there were other problems the state should tackle before access to coverage.
“I think before you talk about access to coverage you clearly have to improve access to the system itself and lower costs first,” he said. He suggested a different health care model for places without access to coverage. Rural communities that have experienced hospital closures, for example, could see free-standing emergency rooms or tele-medicine play a larger role.
The discussion turned back to opioids after a question underscoring the toll that the drugs have taken on businesses and lives.
Dean said that public education on the issue was essential.
“We ought to have a public education campaign like we did for drunk driving or smoking,” he said.
Lee linked the problem to mental health. He said he was particularly interested in highlighting the link between addiction and trauma in the lives of those gripped by opioids.
“We have to look at the mental health problem we have in this state and address it if we are going to address the opioid issue,” he said.
Harwell sees a greater presence of drug courts rather than criminal courts in the state as a way forward.
“We will not incarcerate our way out of this problem,” she said.
Another question posed to all the candidates had to do with work requirements for certain Medicaid beneficiaries.
Harwell said she is in the middle of advocating for that right now.
“We need to provide for those low-income people a safety net while they go through a difficult time, but it does not need to turn into a lifetime entitlement program,” she said.
Neither Dean or Boyd dismissed the idea but wondered if work requirements would actually be a cost-efficient solution.
“I want to make sure it is handled in the right way and doesn’t end up retaining more bureaucracy and more paperwork than it actually solves,” Dean said. He also wanted to make sure requirements would not discourage people from seeking health care.
“The cost of actually monitoring and maintaining that program might be more expensive than the problem itself,” Boyd said.
Lee thought it was necessary to go deeper than just looking at work requirements.
“I do believe that work requirements are a good idea, but I actually think we go further than that,” he said. He thought it is important to incentivize patients to make wise health care decisions.
“We need to be certain that users of that program have some incentive to help us lower that cost otherwise nothing will ever change about the cost for that part of our health care system,” he said.
For his part, Fitzhugh said the question was not actually that relevant to the healthcare situation in Tennessee.
“We don’t have able-bodied folks, we have disabled folks” who get TennCare, he said. He said the only able-bodied people on TennCare were generally pregnant women or children.