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This is the first in an on-going series that will look at a wide range of issues, including the economy, infrastructure and manufacturing, facing Tennessee’s next governor.

Scroll to the bottom of the page to submit topics or questions you’d like to see addressed or put to gubernatorial candidates Karl Dean and Bill Lee. Check back for a breakdown of key health care questions.

Great Smoky Mountains National Park/ Photo by Ivana Cajina on Unsplash

ILLUSTRATIONS BY AYUMI FUKUDA BENNETT | @AYUMIBENNETT

With party nominations clenched, health care officials want the would-be governors to take a moment to craft and sell their vision for health care — one of the most unwieldy, sweeping, and monumental problems facing the candidates.

It’s time for Karl Dean, a Democrat and former Nashville mayor, and Bill Lee, a Republican businessman from Williamson County, to demonstrate how they are thinking about tackling costly, complex health care dilemmas that have cultural, socioeconomic, policy and corporate based roots, said industry professionals across the state.

Both have talked in broad strokes about philosophy but people want to understand what that means. Lee emphasizes deregulation, fighting costs and empowering businesses. Dean talks about how to focus on preventative care as a cost cutting measure and expanding Medicaid.

“The problem is that the talking points will soon become a policy position. That’s what will happen as soon as the August primary is over, but we’re not seeing sophisticated comments. It’s important to take a breath before the general campaign heats up and help politicians take stock,” said Brian Haile, CEO of Neighborhood Health, a few days before the Aug. 2 primary.

The next governor will inherit an industry fatigued from years of health care reform and many Tennesseans beleaguered by rising health care costs and concerns about what the future holds regarding access. The situation could be exacerbated by a potential storm on the horizon that leaves more people uninsured or underinsured in the coming years as

• deductibles keep rising,
• changes to individual health insurance markets leave people priced out of comprehensive plans, unsure of how to apply for coverage, or in lower cost short-term plans that mostly cover catastrophic events with limited payout,
• the late stage economy cycles toward a slowdown per analyst projections,
• whether the state makes progress in educating and training the workforce for skills needed to land next generation jobs with living wages and benefits.

Coverage is a priority for Saint Thomas Health’s CEO, Tim Adams. The next governor needs to “implement policy changes that will increase healthcare access and coverage for all Tennesseans,” Adams said.

“Many Middle Tennesseans are uninsured or underinsured and need access to affordable healthcare, and we need legislators ready to provide a direct response to these community needs including solutions to the rural hospital closures that have resulted in lack of access to care in rural Tennessee, and sound business decisions to bring back dollars to Tennessee we have already paid through previous cuts,” said Adams.

»Dean supports expanding Medicaid, Lee does not. Read some answers from early in the primary.

Governor will grapple with more power as D.C. decentralizes, and govern people who don’t think their voice or experience counts

The costs and physical reality of poor health combined with a decade of politicized rhetoric about the broken system that is crumbling in dozens of counties leaves many Tennesseans feeling powerless and defeated about the potential for improvement.

Hospitals are the lifeblood of small towns and Tennessee’s leading the way in closures. People are seeing premiums rise or find themselves without the skills to land jobs that come with health insurance — which is increasingly the most stable way to secure access to care.

Sandra Rice, a nurse practitioner in Sewanee, said in June that people in her clinic are often without insurance across adult generations — and they think that’s how it has to be.

“They just accept they don’t have health insurance and they won’t feel better,” said Rice. “I don’t think they think their vote makes a difference because it never has. They’ve accepted things aren’t going to change. I think that’s very sad.”

(Tennessee leads the U.S. in low voter turn-out)

Carole Myers, associate professor in the College of Nursing and department of public health at the University of Tennessee in Knoxville, said that since changes to long standing programs are being made at the federal level, it’s going to put more pressure on the next governor.

“It’s a very interesting time for governors as many social problems are being pushed down to the state,” said Myers. 

It’s vital that candidates figure out how to talk to voters about the complexity of his proposals on the campaign trail — and then keep explaining them once in office. Except for the savviest of health care voters, the health care system is so shrouded in complexity or infrequently used that talking about vague approaches doesn’t resonate.

“I don’t hear any one of the candidates being clear,” said Myers. “Where is the message every Tennessean should have access to primary care? I think we need to translate it down to that level.”

»Read more:

Education, jobs, saving access to care: Governor candidates pitch strategies for sustaining rural Tennessee

Competition shakes up Tennessee ACA exchange: Highlights urban-rural divide, ups interest in cost impact

‘Campaign platforms are about ideals, the office is about reality’

Health care leaders across the state want the next governor (and legislature) to not only propose solutions but welcome compromise and innovation. 

“Listening to understand the issue and the rationale for the other person’s position is probably most important (because) from a mutual understanding of the issue, compromise can emerge. Unfortunately, in today’s environment, these skills are often lost here in Nashville and in Washington. The ‘you are with me or you are against me’ mentality is not good for our country or for our state,” said Tina Gerardi, executive director of the Tennessee Nurses Association. 

The new governor will be working with an unproven legislature. Recent sessions have debated several issues but made little headway on issues that position the state’s health care system for the coming decade.

There’s been little to no movement on system issues, including:

• coverage options via Medicaid for lower income Tennesseans, with the exception of requiring the state to pursue a TennCare work requirement
• responding to reforms at the federal level regarding required health insurance benefits or requiring people to have insurance (the state does require car insurance),
• balance billing or other measures to increase pricing transparency; or
• addressing primary care, specialist and mental health provider shortages across the state

Elected officials at the state level will be getting more authority as President Donald Trump’s administration increasingly decentralizes key health policy areas.

But Dean and Lee, no matter who is elected, will be working with a limited budget and an imperative to balance the budget while trying to make good on campaign promises and govern effectively.

“Campaign platforms are about ideals, the office is about reality. Wanting to achieve something and having the resources and legislative support to do it are not the same thing,” said Gerardi.

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