Donald Trump is going to win easily in Tennessee.
Almost everyone, most of all the campaigns for both Trump and Hillary Clinton, accepts this fact, as evidenced by the lack of campaign time spent in the state – and most of the South, for that matter – during this contentious campaign cycle.
But what happens when all the Electoral College votes are counted matters very much for Tennessee, especially with health care.
A Clinton presidency would likely to maintain many of the key policies of President Barack Obama, continuing the clear split between Republicans and Democrats over policies nationally and in Tennessee.
Under that status quo of an administration led by the Democratic nominee, the Republican-dominated state Legislature is expected to continue balking at Clinton’s proposals for health care, as well as immigration.
Clinton, as a U.S. senator from New York and secretary of State and two-term first lady, has a political history people can track. Trump, on the other hand, is making his first real foray into politics and ascended to the Republican Party’s presidential nomination.
With Gov. Bill Haslam’s market-based Insure Tennessee proposal on the shelf, in part because of its ties to Obamacare funds, legislators are studying a 3-Star Healthy plan put forward by House Speaker Beth Harwell to offer health insurance for people caught in an insurance gap between TennCare and the Affordable Care Act.
A pilot project in the works is expected to offer a coverage plan to veterans and people with mental health problems before expanding to some 290,000 people.
It’s not guaranteed to advance, though.
“A lot of the Republicans, if indeed this has now been OK’d by the Clinton White House, they may want to oppose it just like they opposed everything that had Barack Obama on it,” Tennessee political analyst Pat Nolan explains.
“I would say it’s gonna be tough, and there may well be a feeling among the lawmakers, that let’s wait and see what the new president wants to do about health care, whether that’s Trump or Clinton, and we’ll make our decision about Tennessee.”
Clinton indicates she would keep the Affordable Care Act intact but tweak it, while Trump says he would abolish the program.
If a President Trump were to repeal the program, though, the question remains how he would replace it because the Affordable Care Act holds several popular pieces such as requiring coverage of pre-existing conditions and allowing children to stay on parents’ plans until age 26.
“All that tends to make politicians look for some place to be with their friends and say ‘let’s wait and see what happens,’ and then we’ll do something,” Nolan adds.
Kent Syler, Middle Tennessee State University political science professor and chief of staff for former Democratic Congressman Bart Gordon, predicts the impact of either Clinton or Trump would derive from their national policies.
With Clinton at the helm, Syler sees “more of the same” from two Obama terms and even further back.
“And that’s not necessarily meant to be negative, but a lot of people will see that as negative,” Syler says. “I think she will carry on with a lot of the policies we’ve seen the last eight years and, to some extent, the eight years before that and the eight years before that.”
Traditionalists would argue consistency is good, Syler notes, while people looking for change would be more attracted to Trump.
Legislative view
Coming to terms with the Affordable Care Act and expanding Medicaid coverage in Tennessee is critical, according to state Rep. Craig Fitzhugh, a Ripley Democrat who leads the House Minority Caucus.
“It’s there for the taking, and I think she would be supportive of that and work toward getting Tennessee to do that and that would be a huge positive for Tennessee and the economy,” Fitzhugh says.
“We’ve left about $2.5 billion on the table that would circulate and multiply itself and would put us in a situation where we wouldn’t have some of these problems that we have in our state.”
The Insure Tennessee proposal is opposed by Republicans largely because it uses $1.2 billion annually in state taxes paid through the Affordable Care Act. Despite being proffered by Republican Gov. Bill Haslam, in two years it hasn’t reached a floor vote in the House or Senate.
Some Democrats say they believe using those funds to catch people in a coverage gap would help shore up uncertainty in the health insurance market.
The Department of Commerce and Insurance approved premium increases late this summer for BlueCross BlueShield of Tennessee, in addition to Humana and Cigna, which also participate in the marketplace coverage in the state.
But then BlueCross BlueShield dropped its individual coverage plans in three major urban areas, leaving more than 100,000 people to search for new coverage plans starting Nov. 1.
State Rep. Glen Casada, chairman of the House Republican Majority Caucus, says he’s heard Clinton say she wants to tweak the Affordable Care Act. But he’s not sure exactly what her plan will be.
The Trump effect
Radical change may be the cry of Donald Trump supporters, but questions loom large over a potential presidency for the Republican nominee.
His policies are largely undefined, and his relationship with the Republican Party is tenuous at best.
His slogan is “Make America Great Again,” but he’s been unclear how he will achieve such a goal. And whether Republicans get on board with a Trump administration is a mystery, too.
“It’s pretty hard to really gauge on a lot of issues what will happen with Trump because you don’t necessarily know what he really means he’s going to do and whether or not he’ll really do it. Then, you don’t know whether he can get it through Congress,” Syler says.
For instance, would a Trump administration try to – as he has promised – round up millions of undocumented immigrants across the nation and ship them back to their home countries, or will he work toward passage of legislation creating a path to citizenship?
Sometimes he says yes and sometimes he says no, Syler points out.
Trump’s plans for health care – which until this week were defined only as “going to be great – have been less clear.
This week, he gave a little more detail, stating he would immediately repeal the Affordable Care Act, allow insurance to be sold across state lines and block grant Medicaid to individual states.
On the first point, he stated this week he would call a special session of Congress to repeal the ACA immediately following his inauguration. Such a step would not be needed, as Congress will be in session.
He also has yet to lay out a detailed plan to replace the ACA, which has enabled tens of millions of Americans to get health insurance when cost or pre-existing conditions might have prevented that prior to implementation.
Fitzhugh cites that lack of detail as the biggest problem with Trump’s hope to kill the Affordable Care Act.
He concedes the law has problems, pointing toward marketplace premium increases allowed by the Department of Commerce and Insurance and the subsequent pullout of BlueCross BlueShield Tennessee from individual marketplace plans for 2017.
“They need to be worked through and changed. But the bottom line to the positive is we’ve got a lot more people that have health insurance that are not dependent on the public to support them through their own health insurance,” Fitzhugh explains.
He points out Obamacare was originally a Republican plan created by former presidential candidate Mitt Romney in Massachusetts, and he adds he believes it can work if the principles of insurance are allowed to take over.
On the other hand, Casada, an opponent of Obamacare and all its trappings, says he hopes a Trump presidency would entertain the concept of sending the states block grants of Medicaid money and letting them design their own health care programs.
“I think that will be on the table. It’s a total paradigm change for the federal government. I think we could do it and do it well,” he says.
Though the federal government already provides funds for TennCare, Casada says that Medicaid money comes with “a lot of strings,” or mandates. It is unclear whether such block grants would be allowed without states being required to follow federal rules.