The Weekender: Status update on TennCare work req waiver + what changed some opioid Rx writing habits

Spotlighting original BirdDog reporting and why a few headlines from elsewhere matter for Tennessee.



New: Vanderbilt study improved low income kids’ nutrition, exercise but results indicate more intensive approach needed to stem obesity

Children in the intervention group consumed a median of 100 calories less a day than the control group. Families in the intervention group used the community centers more than the control group. Yet, at the end of the study, the median BMI was 17.8 for both groups.


New to BirdDog? Welcome to an experiment to inform Tennessee’s nerd herd. Read what it’s about.




1. How Kentucky’s economic realities pose a challenge for work requirements

Nathan Joo and Elaine Waxman, Urban Institute

The Urban Institute highlights issues, ranging from a lack of opportunity to a historical trend of poverty, that will hinder parts of Kentucky as work requirements for Medicaid and SNAP are rolled out. A handful of counties are exempt from the work requirements, but the Urban Institute researchers project some people could slide deeper into poverty or be forced to move to areas with more jobs as they try to meet requirements, potentially impacting demographics of different parts of the state.

TennCare is working on a work requirement proposal per a mandate from the most recent Tennessee state legislature, although there are questions about how a requirement will unfold in a state that didn’t expand Medicaid. TennCare covered more than a fifth of Tennesseans in 2016 and covers more than half of the births in the state. 

TennCare hasn’t yet submitted a waiver amendment to the U.S. Centers for Medicare and Medicaid Services. The agency is “actively working on a framework for community engagement requirements in TennCare and … closely monitoring the implementation of similar programs in other states,” said Sarah Tanksley, spokeswoman for the agency.

TennCare plans to ask for public input on a variety of components, including:

  •         the people who will have to meet requirements;
  •         activities that count as compliance; and
  •        types of assistance to help people be successful in meeting new requirements.

“Although we have not submitted anything formal to CMS to date, we have been engaged in conversations with CMS officials as well as other state leaders as we consider the details of our plan,” said Tanksley.

The outcome of the Tennessee governor’s race will be a new chapter in how the state approaches TennCare. Former Nashville Mayor Karl Dean, a Democrat, is a proponent of Medicaid expansion while Republican Bill Lee opposes expansion and favors block grants.

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


Speaking of work, the opportunities to stitch together multiple temporary jobs are booming and it’s changing the job landscape…



Susan Fowler, Vanity Fair

App-enabled services (Uber, Lyft, Grubhub and their ilk) have quickly taken root in millions of people’s lives and wooed investors and lenders — as evidenced by jaw-dropping valuations and successful rounds of private and public financings. But their impact on temporary labor remains unclear.

The Vanity Fair piece digs into some of the mechanisms and incentives driving changes not just in the lower-income labor pool but also potential changes in the future for higher level managers and decision makers.

Excerpt: In recent months, however, a spate of lawsuits has highlighted an alarming by-product of the gig economy—a class of workers who aren’t protected by labor laws, or eligible for benefits provided to the rest of the nation’s workforce—evident even to those outside the bubble of Silicon Valley.

Dive in: The Human Cost of the Ghost Economy, Melissa Chadburn for Longreads


3. Coroner sent letters to doctors whose patients died of opioid overdoses. Doctors’ habits quickly changed

Melissa Healy, The Los Angeles Times

A study had intriguing results on how doctors’ learning of a patient’s fatal overdose impacted prescribing habits.

Efforts in recent years to crack down on opioid prescriptions across the state are showing because the “supply and potency of prescription opioids in Tennessee are falling,” per a recent report from the Sycamore Institute. But fatal overdoses continue to climb as use and abuse of illicit drugs rises.

Read the Sycamore Institute report


4. Low-Cost Aldi Amps Up Pressure on Rivals With U.S. Organic Push

Leslie Patton and Craig Giammona, Bloomberg

Grocers are in a race to see who can be the most convenient and attractive to customers amid a shakeup from Amazon. The new offerings from Aldi will put pressure on the organic market, which is almost always pricier, to be competitive.

The grocery wars, as its dubbed by the New York Times, is seeing casualties as consolidation and industry trends push some smaller players to close. It’s upending decades-old reliance on grocers for stable, well-paying jobs in communities around the country.

This week a deal between Albertson’s and Rite-Aid (both small for their respective industries) collapsed thus leaving open the door to other deals as companies push for vertical integration and scale as well as customer volume.


5. The rise and the rainfall of the Roman empire

The Data Team, The Economist

Of course you want to see a chart that overlays rainfall and emperor assassinations in the Roman empire from 27 B.C. to 476 A.D. (I did!)

Wildfires and drought are plaguing countries around the world and a new paper in Economics Letters identifies an association between ancient rainfall patterns and how long Roman emperors were in power which speak to a link between climate and civil unrest.

Excerpt: “The academics hypothesise that lower precipitation reduced crop yields, leading to food shortages and eventually starvation for soldiers stationed at the empire’s frontiers. As a result, troops were more likely to stage mutinies and assassinate their emperor. …. More broadly, it has been long established that adverse weather causes economic shocks that lead to unrest, and even to civil war.”


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