Dr. Carole Myers: We continue a recent interview with Gordon Bonnyman, co-founder of the Tennessee Justice Center, on the impact in Tennessee of the federal mega bill that we have been examining this summer. What do you anticipate to be the macroeconomic impact of the mega bill on the state of Tennessee, and maybe with a special look at our rural communities?
Gordon Bonnyman: The next 10 years, and that's the budget horizon that the nonpartisan Congressional Budget Office, or CBO, looks at when it estimates the effects of these bills, they have estimated we will lose $70 million a year coming out of federal funding for the infrastructure in Tennessee through the Medicaid program. And that's just federal money. And remember, Medicaid is a state federal matching program, so if you pull out the federal dollars, you're also pulling out for every $2 of federal funds not spent, you're not spending another dollar of state funding that goes into paying for health care and paying health care providers. We're really looking at something closer to a billion dollars a year will come out, on average, will come out of funding for the health care system. Tennessee has the unhappy distinction of being one of the states with the highest rate of rural hospital closings in the country, and we've lost a lot of rural hospitals over the past decade, and the ones that remain are precarious, given that we're going to be taking more money out of the system going forward. Congress, when they passed the mega bill, because there was nationwide alarm about the effect on rural hospitals in particular, created what they called a Rural Health Transformation Fund, which will spend $5 billion a year for five years to be distributed across over 1000 hospitals in 50 states. We don't know exactly how much of that is going to ultimately make its way to hospitals. What we know is that the overall impact of the mega bill, according to the non partisan CBOs, to take $1 trillion in federal funds out of the health care system over the next decade. You can't take that volume of money out of a system that's heavily reliant particularly rural hospitals and rural health care providers are very reliant on Medicaid. You can't take that volume of money out of the system and then make up for it by putting back $5 billion a year for five years to be distributed across all those hospitals. There will be an additional that's a $50 billion fund over 10 years, $5 billion is allocated more or less in proportion to the size of the state. There's another $5 billion that is totally discretionary, and we have no idea how that's going to be spent.
As you think about your work in healthcare, advocacy and justice in the state, what are your current priorities? What must we do?
I think right now, the urgent priority is to let people know that are getting their insurance through the Affordable Care Act marketplace, that enhanced premium tax credits are going to expire at the end of this year, unless Congress renews them. Congress, even though it's extending all sorts of tax breaks in the mega bill, did not see fit to extend the tax credits that make health insurance affordable for some 200,000 working families in Tennessee.
