Gubernatorial candidates Bill Lee and Karl Dean appear to be cast in a similar mold – business-friendly moderates.
But when it comes to key questions, the difference between them is as wide as the Tennessee River is long. And the first separation runs along their ideas for Medicaid expansion.
Democratic candidate Dean, a former two-term Nashville mayor, makes no secret of backing Medicaid expansion for some 300,000 Tennesseans caught in a coverage gap. He contends the state has lost about $4 billion in federal funds since the Legislature turned down Gov. Bill Haslam’s Insure Tennessee plan, mainly because of partisan politics – not pragmatic policy – in a General Assembly where Republicans hold supermajorities in both chambers.
The loss of that money means lower reimbursements for hospitals, 11 of which have closed in the last few years, mostly in rural areas, and he says he can make a difference in a state where polls show a majority of people back expansion.
“The best way to get Medicaid expansion in the state of Tennessee is to elect me governor. It’s self-serving, but it’s the fact. You elect a Democratic governor, you elect somebody like me who’s campaigned on this issue. That puts enormous pressure on the Legislature,” Dean says.
Dean, speaking at a Healthy Tennessee symposium on opioid abuse, reiterates his stance as part of the solution for fighting the epidemic, which clamed 1,776 lives statewide in 2017, and he points toward Virginia as a state putting Medicaid expansion to use for treating addiction and mental illness.
Lee, a Franklin cattle ranch owner and chairman of the Lee Co., takes the opposite view.
“I continue to oppose Medicaid expansion under Obamacare, primarily because I think it’s an unsustainable program, a federal spending program that will … continue escalating costs and ultimately an unstable environment,” Lee says.
He says Tennessee needs to come up with a new approach, one that shouldn’t repeat the same mistakes made under TennCare that, he contends, nearly bankrupted the state more than a decade ago. Under former Gov. Phil Bredesen, who is running for the U.S. Senate, the state removed about 250,000 people from TennCare rolls because it couldn’t afford to pay for them.
Expanding Medicaid under the Affordable Care Act is “really expanding a federally driven and federally mandated program,” Lee adds. “But I want to create a Tennessee solution that works with our doctors and patients and providers and our universities and research centers really to create a solution that empowers our providers to provide care in a cost-effective way.”
He says Tennessee has the resources to “craft” a plan to replace what he terms a “fundamentally flawed” system, one with no incentive at any level to lower costs.
Lee isn’t concerned, though, about the state leaving money on the table or allowing the taxes Tennesseans pay toward the Affordable Care Act to go to other states rather than flowing back here.
“There’s no free money, and money from the federal government doesn’t come free. If it’s, in fact, creating a scenario that’s unsustainable down the road, whether other states take it or not, I don’t think it’s a good idea for Tennessee to pursue it,” Lee says.
Part of Tennessee’s problem lies in the health of its residents, with obesity rates among the nation’s highest and overall health among the worst in the country, Lee contends. All of that leads to a situation in which 80 percent of the cost of health care is linked to preventable, chronic diseases, he notes, predicting a “tsunami” of health care expenses unless the state gets a handle on its health.
Considering most people would rather eat potato chips than brussels sprouts, Lee as governor has a tough job ahead. Higher taxes on beer, burgers and pizza could help, even if it’s not the Republican way.
Medical marijuana matters
Legislation setting up a system for growing, processing, prescribing and using medical marijuana made its way further than ever in the General Assembly this year before stalling in the Senate Judiciary Committee.
It’s bound to come back with a vengeance in 2019. Two Republicans, Rep. Bryan Terry of Murfreesboro and Sen. Steve Dickerson of Nashville, both anesthesiologists, are planning to sponsor legislation in 2019 dubbed the Tennessee Responsible Use of Medicinal Plants Act (TRUMP Act) for medical use of cannabis. And Republican Rep. Jeremy Faison of Cosby in East Tennessee is planning a caption bill to fill in the blanks.
With a Bill Lee administration in place, though, they might not fare too well. Lee says he opposes marijuana for recreational purposes, and because of that he has “deep concerns” about medical use, too. In other words, he thinks medical weed is only a puff away from recreational.
“I certainly want to help Tennesseans who need solutions for pain and other ailments,” Lee says. “But I think we have yet to fully explore the use of low-THC CBD oils as potential options, and I want to look first at expanding those options before going to medical marijuana. So at this point, I’m opposed to it.”
All sorts of low-THC stuff is on the market, if you can pass an employment drug test after using it. That might be one thing the Legislature wants to consider: how to keep people from getting fired for using hemp-based products.
But what you really want to know is where Dean stands on medical pot. If you guessed he takes a different outlook, you’d be right.
“I’m basically for it,” he says of medical marijuana. “I sort of take the position that if the medical profession is saying there are illnesses or pain that medical marijuana can be used in a way to alleviate people’s suffering, to help them, then we shouldn’t stand in the way of that happening.
“I think the vast majority of Tennesseans are for it. I think most people in the country are for it, frankly.”
Dealing with Dreamers
Gov. Bill Haslam and state Rep. Mark White of Memphis, both Republicans, have worked the past few years on behalf of DACA (Deferred Action for Childhood Arrivals) students and Dreamers, young people brought to America as small children illegally by parents.
They want to give them a chance to pay in-state tuition to attend Tennessee colleges and universities, but keep hitting a wall and not the one President Trump and others want to build at the border, more like a Republican barrier in the House chamber.
Immigration, illegal and otherwise, was a constant theme in the Republican gubernatorial primary as well, with Rep. Diane Black and Knoxville businessman Randy Boyd hammering away at it. Lee didn’t really focus on that during the election and declined to comment on the strategy of others.
Yet he doesn’t appear to be ready to back a change in the law for Dreamers.
“I think we just have to follow the law,” Lee says. “We’re a country based on the law and we need to follow the law, and that’s how I would create policy around immigration is to follow the law.”
Dean, you ask? Of course, he favors allowing in-state tuition for the Dreamers.
“For me, it’s just the right thing to do because, No. 1, these young people came here through no fault of their own. They were brought here at an early age by their parents,” Dean says.
“They’ve been part of our community. They’ve gone to school with our kids. They’ve gone to church with us, they shop, they buy things, they pay sales tax, their families have. And they’re gonna live in Tennessee, I think, and it’s in Tennessee’s interest to see them do well and go to college and be productive members of our state.”
Based on those items alone, it appears Dean and Lee would disagree on daylight and dark.
We’ll continue to see their differences in debates scheduled Oct. 2 in Memphis, Oct. 9 in Kingsport and Oct. 12 in Nashville where people can watch them go head-to-head.
In announcing his commitment to the debates, Lee says, “I believe Tennessee can lead the nation and that means challenging the status quo and providing conservative leadership to keep Tennessee moving in the right direction. I look forward to continuing to share my vision with Tennesseans on the campaign trail and from the debate stage this fall.”
Just exactly what he means by challenging the status quo and sharing his vision is uncertain. He hasn’t given enough details for anyone to gauge where he stands on most things, either by strategy or he doesn’t have any specific ideas.
Dean, on the other hand, is an open book, saying, “I’d love to see us go beyond just having a couple of these real structured televised debates.” He says he wants to travel from town to town and hold public square discussions. Lee’s not biting.
While they’re trying to hit every county in the state during these 70 days before the Nov. 6 election, at some point Lee, the early favorite in a red state, needs to tell Tennessee what he plans to do if elected. Dean already is.
Sam Stockard is a Nashville-based reporter covering the Legislature and state politics for the Memphis Daily News. He can be reached at email@example.com.