Freedom Line Blog

The Tennessee General Assembly recently passed important legislation to repeal the state’s Certificate of Need (CON) requirements for acute care hospitals and other critical healthcare services. Pending Governor Bill Lee’s signature, the bill paves the way for more choices and better-quality care for patients across the state.

CON laws compel hospitals and other healthcare providers to demonstrate a “need” for and to receive special government permission to build new facilities and offer certain new healthcare services. Not only is that approval process governed by a government board unaccountable to voters, but incumbent providers also get a say in whether new facilities are permitted to open or new services can be offered by competitors in their geographic footprint.

Simply put, CON laws empower a board of unelected government bureaucrats to insulate incumbent healthcare providers from competition and limit access to care for patients.

The detrimental effects of CON laws have been felt across the Volunteer State. According to a recent report by the Beacon Center of Tennessee, which examined the impact of the state’s CON laws over a more than two-decade span from 2000 to 2022, as many as 5.5 million Tennesseans were denied increased access to healthcare services and Tennessee communities lost over $700 million dollars in direct investment as a result of the state’s CON denials during that time period.

Given the sizable negative impact CON laws have, the efforts of numerous legislators from across the state to pass significant reform, including phasing out Tennessee’s CON requirements for acute care hospitals, merits significant praise.

CFIF, therefore, joins countless Tennessee patients, community leaders, healthcare providers and other leaders in expressing appreciation for the General Assembly’s passage of critical CON reform this session. Tennessee patients can now look forward to increased access to the affordable, high-quality care they depend on closer to home.

Specifically, CFIF would like to thank the following members of the Tennessee General Assembly for their thoughtful leadership and many years of hard work on this issue:

• House Speaker Cameron Sexton (R-Crossville)
• Senator Bo Watson (R-Hixson)
• Representative Johnny Garrett (R-Goodlettsville)
• Senator Rusty Crowe (R-Johnson City)
• Representative David Hawk (R-Greeneville)
• Senator Brent Taylor (R-Memphis)
• Senator Shane Reeves (R-Murfreesboro)
• Senator John Stevens (R-Huntingdon)
• Senator Paul Bailey (R-Sparta)
• Senator Kerry Roberts (R-Springfield)
• Senator Bobby Harshbarger (R- Kingsport)
• Representative William Lamberth (R-Portland)
• Representative Jeremy Faison (R-Cosby)
• Representative Clark Boyd (R-Lebanon)
• Representative Mary Littleton (R-Dickson)
• Representative Esther Helton-Haynes (R-East Brainerd)
• Representative Ron Travis (R-Dayton)
• Representative Lowell Russell (R-Vonore)
• Representative Mike Sparks (R-Smyna)
• Representative Jay Reedy (R-Erin)
• Representative Jody Barrett (R-Dickson)
• Representative Bud Hulsey (R-Kingsport)
• Representative Tim Rudd (R-Murfreesboro)
• Representative Sabi Kumar (R-Springfield)
• Representative Tim Hicks (R-Gray)
• Representative Jake McCalmon (R-Franklin)
• Representative John Crawford (R-Bristol/Kingsport)
• Representative Paul Sherrell (R-Sparta)
• Representative Rick Eldridge (R-Morristown)
• Representative Aron Maberry (R-Clarksville)
• Representative Rebecca Alexander (R-Jonesborough)
• Representative Justin Lafferty (R-Knoxville)
• Representative Timothy Hill (R-Blountville)

First Florida, then Texas, and now Kansas and Tennessee have been told by the Obama administration that unless they expand Medicaid under the rules laid out in ObamaCare the federal government will withhold payments from local hospitals.

Florida’s Republican Governor Rick Scott is so angry at the move he’s promised to sue the Obama administration for violating a 2012 U.S. Supreme Court ruling prohibiting the feds from conditioning Medicaid funding on ObamaCare expansion.

Yet this is precisely what the Centers for Medicare and Medicaid Services (CMS) is doing. According to Kaiser Health News, CMS “confirmed Tuesday that it gave officials in [Kansas and Tennessee] the same message that had been delivered to Texas and Florida about the risk to funding for so-called ‘uncompensated care pools’ – Medicaid money that helps pay the cost of care for the uninsured.”

“Medicaid expansion would reduce uncompensated care in the state, and therefore have an impact on the [Low-Income Pool], which is why the state’s expansion status is an important consideration in our approach regarding extending the LIP beyond June,” a CMS official warned.

The reason states have resisted expanding Medicaid under ObamaCare is that it transforms a program currently helping discrete populations – e.g. pregnant women, the disabled, elderly, blind, and children from needy families – into a universal, taxpayer-funded health insurance program for every person earning less than 133 percent of the federal poverty level. That change translates into large amounts of new spending that will eventually lead to increased state taxes.

By making a state’s refusal to expand Medicaid a factor in deciding whether Medicaid dollars will continue to flow, the Obama administration is directly flouting a prohibition handed down by a 7-2 Supreme Court majority (liberal Justices Kagan and Breyer sided with their five more conservative colleagues). If the Supreme Court wants to ensure that its rulings will be taken seriously, it should fast-track Florida’s lawsuit and let the Obama administration know it must follow the law.

Another news cycle, another Republican governor decides to expand Medicaid with ObamaCare dollars.

Last Friday, Tennessee Republican Governor Bill Haslam joined Pennsylvania’s Tom Corbett, Indiana’s Mike Pence and others in trying to carve out a middle ground between a straight yes or no on expansion.

Haslam hasn’t committed himself to specifics, saying only that “sometime this fall” his administration will submit an alternative plan to federal regulators.

States like Wisconsin, Indiana, Pennsylvania, Arkansas and Iowa have won various levels of approval to use ObamaCare’s increased Medicaid funding to provide subsidized health insurance plans to some of the poorest members of their populations.

Expanding Medicaid is a tempting offer because the federal government pays for about half of every dollar spent on the state’s program. ObamaCare makes taking the plunge almost irresistible since it pays for every dollar of expansion until 2017, and 90 percent of all new spending until 2020.  For sitting governors with term limits, that translates into an opportunity to get lots of credit for helping poor people before most of the bill comes due.

The politics of ObamaCare are constantly evolving, and the lesson for conservatives about the law’s Medicaid expansion is this: Unless there is a credible alternative to growing government, many politicians will opt for good press and worry about the policy implications later.

Heading into the 2016 presidential cycle, there needs to be a way to determine which ideas adhere to constitutional principles, preserve the free market and bolster human flourishing – which includes access to health care.

The sooner, the better.

Conservatives could probably learn a thing or two from Saul Alinsky. Bear with me here. While Alinsky may have promoted thuggish means in the service of repugnant ends, it doesn’t mean the man didn’t have some genuine insights into political strategy that — applied with a dose of morality — could help the right.

One of Alinsky’s tactics (to be specific, it’s actually part of the 11th rule for radicals) is to personalize attacks on your opposition (i.e., go after a specific individual rather than an abstract entity). This also works, however, in reverse. When you’re trying to portray the suffering caused by big government, use a human interest example rather than generically inveighing against state excesses.

My friends over at the Beacon Center of Tennessee (I worked there back when it was the Tennessee Center for Policy Research) have put this principle to great use in a new video that makes both the moral and economic case for abolishing the Volunteer State’s death tax. In the story of Roger Blackwood, a 77 year old Tennessee farmer whose family stands to lose the products of his life’s work because of the estate tax, they’ve found a compelling narrative that underscores an important point: the estate tax amounts to the outright theft of a family’s legacy. This is, by my lights, utterly brilliant:

Three cheers today for my (intermittent) home state of Tennessee, which has just passed a package of education reforms that should be held up as national models:

Cheer # 1 — The Volunteer State is doing away with tenure-based layoffs, in which teachers who’ve been on the job the longest are insulated from dismissal regardless of job performance.

Cheer # 2 — Tennessee is abolishing the cap on public charter schools, institutions that are controlled by the government but given much greater administrative flexibility than traditional public schools. This will allow for much broader educational competition — a move that will create more opportunities for children trapped in failing institutions.

Cheer # 3 — The state is also creating universal access to charters. Previous iterations of the policy had restricted which students were eligible to attend the schools.

With these reforms, the state of Tennessee has shown that it understands the most important principle of public education: the needs of the students come before those of bureaucrats and public employees. We salute their courage and look forward to the results.

Join CFIF Corporate Counsel and Senior Vice President Renee Giachino today from 4:00 p.m. CST to 6:00 p.m. CST (that’s 5:00 p.m. to 7:00 p.m. EST) on Northwest Florida’s 1330 AM WEBY, as she hosts her show “Your Turn.”  Today’s star guest lineup includes:

4:00 p.m. CST/5:00 p.m. EST:  Edward Lengel, Author, “Inventing George Washington: America’s Founder, in Myth & Memory”

4:30 p.m. CST/5:30 p.m. EST:  Attorney Jon Harris, Ogletree, Deakins, Nash, Smoak & Stewart, P.C., Nashville, TN — Frivolous Lawsuits/Pleading Standards/Due Process and CFIF Amicus Curiae Brief

5:00 p.m. CST/6:00 p.m. EST:  Jordan Sekulow, Director of International Operations, American Center for Law and Justice — Iran’s Nuclear Weapons Program

5:30 p.m. CST/6:30 p.m. EST:  Lucy Morrow Caldwell, Executive Director of Pass the BBA

Please share your comments, thoughts and questions at (850) 623-1330, or listen via the Internet by clicking here.  You won’t want to miss it today!