Dr. Carole Myers
Welcome to HealthConnections, the show about people, health, and policy. I'm Dr. Carole Myers. H.R. 1, also known as the Big Beautiful Bill, was signed into law on July 4, 2025. Today, Michele Johnson, who is the executive director of the Tennessee Justice Center, is here to discuss changes to TennCare, Tennessee's full Medicaid replacement program. Welcome, Michele.
Michele Johnson
Thanks for having me.
What major changes to TennCare will be implemented for the remainder of 2026 and through 2027?
The major change is that people who are refugees or asylees, you know, who left their country with nothing, many of them, folks who work for the U.S. military in Afghanistan or Iraq, those people will, as of today, no longer be eligible for Medicaid. And so, we got a call from a social worker about two families from Afghanistan, refugee children who are in hospice, and they have received notice that they can no longer get hospice care. So their family members worked for the U.S. military for decades. They left behind everything and ran for their lives. And these humanitarian status people will no longer be eligible for health coverage. H.R. 1 was designed really to punish states that expanded Medicaid coverage, and because we're sadly one of 10 states that refuse to do so, we will be spared the worst of the cuts of the bill. Work requirements, for instance, will apply to the majority of the states, but won't apply to us. And so, what those penalties mean is that we will have no hope of expanding coverage to those uninsured Tennesseans in low-wage jobs, waitresses, and home health aides. The broadest impact that's happened just in this year, is this Congress's failure to extend premium subsidies under the Affordable Care Act, means that over 74,000 people have lost coverage since last year at this time. So it's about 14% of those on the Affordable Care Act are now without coverage because of the failure to extend those subsidies.
Michele, you've outlined some of the personal impact of the changes that are coming about because of H.R. 1 to individuals and individual groups. Can you talk about what the implications are for the state of Tennessee with what's coming down the pike or has already occurred with Medicaid?
Well, the state will have less money. You know, the the H.R. 1 was cutting funding for Medicaid, and so the state will have less funds for the Medicaid program. And how that will impact the state in terms of particular policies, we do know that there was a huge push before H.R. 1 to simplify enrollment to make it less administratively challenging for states, and to make it not so bureaucratic for people who are sick to get health care. All of the push to make it simpler is now gone.
What can individuals and the state do to potentially offset the effects of the upcoming changes?
Well, I think letting their elected officials know that healthcare is vitally important for them is super important. We know that the majority of Tennesseans believe that people should have healthcare, and we have elected officials in Washington voting against that interest consistently.
This is Dr. Carole Myers, joined today by Michele Johnson, the Executive Director of the Tennessee Justice Center. Thank you for listening to HealthConnections. All past episodes are available at WUOT dot org.
