WHY CAN’T TENNESSEE LAWMAKERS DO HEALTH CARE MATH?

Just what is it exactly about opting out of federal health care money that Tennessee lawmakers don’t understand?

Is it the dollars or the cents? Apparently, we could spell that cents more like this: sense. As in common sense.

When Tennessee’s governor and lawmakers opted out of the Affordable Care Act because of baldly rash, partisan spite for the president and his signature “Obamacare” some years ago (and again this year by refusing to vote out of committees Gov. Bill Haslam’s Insure Tennessee version which would expand Medicaid, known here as TennCare), they were following through on a long-standing precedent.

Some 21 years ago when Tennessee first began the TennCare program, state leaders then also opted out of federal funding. It seems they were so optimistic that hospitals would no longer have uncompensated care in Tennessee, that they made the Volunteer State the only state in the nation left out of the annual Disproportionate Share Hospital payments known as DSH (pronounced “dish”).

Those payments have for years helped hospitals in other states manage the burden of uncompensated care from uninsured or under-insured patients — life-saving care that by law hospitals cannot refuse.

Common sense should tell our leaders not to leave money — especially our own money that we pay to the tax man every April 15 — sitting on the table. But common sense — and cents — seem to be lacking in Tennessee.

By opting out of the ACA and refusing to allow a full Tennessee General Assembly vote on Insure Tennessee, our lawmakers — including key Senate committee members Todd Gardenhire and Bo Watson of Chattanooga and Mike Bell of Riceville — turned down the federal offer to pay for a two-year pilot that would cover 285,000 working poor Tennesseans at 100 percent, $2.8 billion. Would it cost us too much after that? Why, no, the federal government committed to pay for 90 percent of the program’s cost thereafter.

So, bottom line, we won’t get a return on our federal tax dollars because our lawmakers are leaving the money on the table for someone else to use.

The same thing has been happening in Tennessee regarding our hospitals’ burden for uncompensated care — another $2 billion a year, according to Craig Becker, president of the Tennessee Hospital Association.

While Georgia hospitals, for example, received more than $34 million through their state and federal matching DSH payments in 2014 alone, Tennessee hospitals have had to beg our congressional leaders year after year for a series of legislative “patches” that brought between $60 million and $80 in the occasional year. Last year Tennessee didn’t get any DSH money because the patch bill didn’t get through Congress.

Erlanger’s share of DSH money is about $8.5 million, and Steve Johnson, Erlanger vice president of government relations, told Times Free Press reporter Kate Belz what not being able to count on that money means: “The looming threat of a big gap in DSH funding creates a tremendous amount of instability and uncertainty,” he said.

Republican Sens. Lamar Alexander and Bob Corker ultimately had to lobby U.S. Health and Human Services officials to agree to an administrative patch to bring in the money for the next decade.

It’s another temporary fix, but at least this time there will be some reliability for the next 10 years.

This longer-term patch was passed as part of a fix for a major health care bill — the Medicare Access and CHIP Reauthorization Act of 2015. It overhauls a 1997 formula that each year threatens to significantly cut physicians’ Medicare payments. This year the cut would have been about 21 percent.

Congress has had to save the physicians’ funding 17 times with legislative “patches,” so apparently it isn’t only Tennessee that is in health care needs denial.

But it is still just Tennessee state lawmakers who keep leaving our money on the table for everyone else to use.

When will we say we’re through with that kind of wastefulness — and with them?