The Weekender: Excavating TN’s Medicaid expansion flop + SEC questions for La Croix

Spotlighting what you might have missed on BirdDog and why a few headlines from elsewhere matter for Tennessee.



Anesthesia group, BCBST quarrel puts Middle Tennessee hospitals in limbo


Nashville imports Pacific Northwest tech training model to ease tight labor market

Programs that expand the size of the workforce will be critical to sustain Nashville’s growth, particularly as the health care sector tries to establish itself as a health tech leader.


Health:Further’s David Shifrin invited me on to The Future of Health podcast to talk about why I’m undertaking the BirdDog experiment and my observer’s perspective on Nashville’s health care scene.

Episode summary, June 19, 2018: Holly Fletcher founded BirdDog earlier this year to bring “slow news” to healthcare, tech and economic issues in Tennessee. The goal is to provide deep reporting on issues that affect the state, including some – like healthcare – that ripple out to the rest of the country. With Nashville as a national hub for the healthcare industry, the response of Tennessee health systems to policies and trends have an effect elsewhere. In this conversation, we talk about Fletcher’s approach to covering the news (lots of data), the trends people are talking about (transparency and balanced billing), the things making healthcare companies nervous (again, transparency and balanced billing), challenges to making long-term progress in those areas, and holding policy makers accountable by asking hard questions.

Have a listen.



1. Three D.C.-based Medicaid experts talked about Tennessee’s inability thus far (it’s been three legislative sessions since Insure Tennessee was pitched) to expand the program to include options for the state’s working poor.

Rhetoric has come down to arguments that dance around legislators outright saying whether health care is a right or privilege, but Barbara Smith, a longtime health policy professional, said that doesn’t have to be the focus.

Tennessee’s public discourse around Medicaid expansion was centered around widespread dislike of Obamacare, or the Affordable Care Act. The 2016 presidential election upended momentum around the ideas from the listening sessions of the 3-Star Healthy task force, convened by governor-hopeful House Speaker Beth Harwell, R-Nashville.

The speakers, hosted by the Tennessee Justice Center and moderated by John Seigenthaler, pointed out how the state’s discussion didn’t dig into potential improvements in health from increased pathways to care.

It’s too early to proffer more than anecdotes from early expanders such as Arkansas and Kentucky, but initial reports point toward improvement. Neither of those Tennessee neighbors have been that much healthier than the Volunteer state.

“We don’t know that yet, we’ve only had four years,” said Andy Schneider, research professor at Georgetown University’s Center for Children and Families. “For me personally I don’t see how it could make things worse.”

For more panel coverage, head over to BirdDog’s Twitter feed.

Recent Medicaid headlines:

Vox: Federal judge blocks Kentucky’s Medicaid work requirements

IndyStar: Federal judge’s rejection of Kentucky’s Medicaid work requirements threatens Indiana’s program

BirdDog: The TennCare work requirement bill isn’t just about work — it spotlights how lawmakers are bolstering the dependence on jobs for health care access


2. Amazon’s Pharmacy Deal Threatens Retail Drugstores

Jonathan D. Rockoff and Joseph Walker, The Wall Street Journal

It’s safe to say that if you haven’t heard Amazon has its sights set on health care then… wait, I really don’t know how you came to hear about BirdDog if that’s the case. Because Amazon’s got way more brand recognition.

In any event, the Seattle-giant rattled the health care world this week with its purchase of an online pharmacy causing retail pharmacy stocks to dip.

This piece from New Food Economy is probably a great read for people wondering how Amazon changes businesses once it acquires them:

Email reveals who’s really paying for Amazon Prime’s new discount at Whole Foods: vendors


3. Startups Front Cash to Homebuyers in Bidding Wars

Noah Buhayar and Patrick Clark, Bloomberg Businessweek

Based in Seattle — which undoubtedly bests Nashville for home buying craziness — FlyHomes is a start-up that fronts cash to shoppers so they can make an all-cash bid.

Seattle’s been the nation’s hottest housing market for nearly two years as its growing tech sector throttles growth. Homebuyers without deep pockets struggle to win out in competitive processes.

FlyHomes is Seattle-centric for the moment. But wouldn’t a service like that be interesting in Nashville, where all cash bids can quickly seal a deal?

Deeper dive into why A-list VC investors back it: FlyHomes raises $17M to purchase homes for buyers battling cash offers in hot housing markets, GeekWire


4. The SEC Has Had Its Own Questions About LaCroix

Jennifer Maloney, The Wall Street Journal

National Beverage Corp., the company behind the nearly ubiquitous cans of fizz (I’m partial to the grapefruit) has not answered questions from the U.S. Securities and Exchange Commissioner about some of its sales measures, including “velocity per outlet” and “velocity per capita.”

The company in notoriously quiet about its product and business, and is listed as FIZZ on NASDAQ.


Other reads I stumbled across this week

CNBC: GM’s new 39-year-old CFO Dhivya Suryadevara is making history