This Red State Almost Expanded Health Insurance to 280,000 Poor People - Then Koch Group Got Involved

Tracy Foster calmly explains that when she goes to doctors, all they can do is "poke" -- she makes a poking motion with her hand -- her bladder back into place, because it is falling out of her body. She has bladder cancer. She needs to have surgery immediately, the doctors all agree, but she doesn't have insurance and can't get the operation unless she hands over $8,000 up front ($2000 for the doctor, $6000 for the hospital). She doesn't have that kind of money or a health plan to cover it. 

Foster had one surgery for her cancer when she was covered by TennCare, Tennessee's version of Medicaid, state-run healthcare for the poor. But she was dropped, she says, because her daughter turned 18, and as an adult with no dependent children she's no longer eligible for coverage. She's spent most of her life working in the health industry, tending to Alzheimer's patients in nursing homes, working in a hospital lab, administering EKGs. So she has no illusions about her situation. "They found the lymph nodes near my bladder enlarged," she says. 

She's tired and very sick, but she dragged herself down to Nashville from her home three hours away to take part in a Moral Monday demonstration for Insure Tennessee, a healthcare proposal that would bring insurance to an estimated 280,000 low-income people in the state. The plan, pushed by Republican Gov. Bill Haslam, aims to expand Medicaid coverage to Tennesseans who live on less than 138 percent of the federal poverty level ($16,000 for an individual and $27,000 for a family of three). It also aims, desperately, to differentiate itself from Medicaid expansion that's associated with the Affordable Care Act (Tennessee is one of 22 states that refused to expand Medicaid under the ACA).

The plan contains potentially onerous premiums and copays as well as punitive measures like locking people out when they fail to make their payments. In another concession to anti-Obamacare conservatives, when the federal subsidy to the state drops from 100 percent to 90 percent, Tennessee's hospitals have promised to pick up the slack.

On Monday afternoon, Tracy Foster joined clergy and secular activists (clerical white collars for days, nurses in white coats and many students) in a statehouse demonstration to support Insure Tennessee, organized by the community group Moral Movement Tennessee. They massed in the bright, expansive Capitol lobby outside of the Senate chamber. They waved palm fronds and crosses, singing songs like "This Little Light of Mine." Some suggested that if Jesus were around today he probably wouldn't be in favor of letting the poor die just to spite the President, and pleaded with legislators to "not do the politically expedient thing, but to do the right thing," as activist Brian Merritt put it in a fiery speech. 

As that night's Senate session beamed through a large flatscreen in the hallway, Foster leaned back against a wall by the TV, looking small. She said she didn't think anyone who knew how hard her life is could oppose a plan that would give her, and thousands like her, health coverage.  

"I would hate for them to go through the pain I go through, but if they would feel one ounce of the pain that I go through everyday they would be for it. They would," she insisted. 

They didn't. The next day, the plan died in the Senate Commerce and Labor Committee, devastating people like Foster and dashing the hopes of activists and sympathetic lawmakers who'd been energized by last week's resurrection of the proposal, after it had been voted down at a special emergency session in February. The governor has previously suggested that he would continue trying for some version of the legislation, but there does not seem to be a likely legislative route to reviving it this year, advocates say. 


It should not be surprising that anti-government conservatives backed by the Koch brothers gave their all to torpedoing the plan. The day of the Moral Monday protest, Tennessee's chapter of Americans for Prosperity, the conservative advocacy group (David Koch heads AFP's Foundation), had relaunched its radio campaign against Insure Tennessee. 

AFP-Tenn has relentlessly hammered the proposal's parallels to Medicaid expansion under Obamacare, making things exceedingly awkward for its Republican backers. "Obamacare has been a disaster. Expanding Obamacare in Tennessee will be the same," the latest ad said. 

In February, when the plan was first introduced and defeated, AFP-Tenn pulled out all the stops. It ran ads urging Tennesseans to call their representatives and bussed members in red shirts to the statehouse. (Pro-healthcare advocates claim some were shipped in from out of state, but that has not been independently confirmed.) 

As NBC and local media outlets reported at the time, AFP members jammed into the Capitol, intent on spooking legislators who had not yet made their stance on the plan public. A handful of unlucky Republican lawmakers found themselves sharing poster space with a picture of President Obama in sinister ads accusing them of "betraying" Tennessee. The fear campaign worked. The plan failed in the emergency session, despite a poll—eagerly distributed by the governor's supporters to GOP legislators— that although 85 percent of Republican voters oppose Obamacare, only 16 percent opposed Insure Tennessee, reported NBC. 

"Radio ads, social media and grassroots activism led by AFP-TN was a significant factor in the defeat of the Insure Tennessee plan," the group boasted in a press release.

NBC noted at the time that the effort reflects a larger AFP strategy of impacting politics at the state level, especially in states in the South and West with Republican-controlled legislatures, where "policy debates are between more moderate Republicans and the party's conservative wing." 

"The vote was one of the clearest illustrations of the increasing power of AFP and other conservative groups funded in part by the Koch brothers," NBC pointed out. 

Andrew Ogles, director of AFP-Tenn, laughed off intimations of Koch conspiracy, saying, "Obviously David Koch is our chairman and we appreciate everything he does for us, but we're grassroots.” Ogles says that the group's opposition to Insure Tennessee is rooted in the ACA. "From the onset we've opposed Obamacare. Insure Tennessee is funded by the Affordable Care Act and it's an extension of Obamacare." Toppling the ACA is a priority and their opposition to insuring low-income Tennesseans is part of that plan. 

He says there are huge problems with the state's healthcare system, but believes there are better solutions, citing two that AFP is working on: one is opening up treatments that have passed phase 1 to terminal patients, and the other is telemedicine. "You can speak to your doctor via the phone, or FaceTime," he says brightly. 


On Tuesday, the day of the Senate Commerce and Labor committee vote, hundreds of Insure Tennessee supporters poured into the legislative plaza, in a demonstration organized by the Tennessee Justice Center. They came in purple T-shirts with "Insure Tennessee Now!" scripted on the front and back, and many carried signs with their vocations printed above their support for the plan. There were nurses for Insure Tennessee, grandmas for Insure Tennessee, veterans for Insure Tennessee, among many others. 

Suzanne Lanier, a "grandma for Insure Tennessee," said she doesn't see the downside of a plan that gives people insurance without adding taxes. "It will insure veterans, and people who are working, but who can't afford insurance," she said. "Reality isn't reality until it happens to you," she said wisely, pointing out that the legislators who might scuttle the plan are among the lucky Tennesseans who have state-backed health insurance. 

Ronald Huddleston, a 77-year-old veteran, made a sharp point about the questionable Christian values on display. "The people who run this building consider themselves to be conservative Christian. I always thought the definition of a conservative Christian was one who followed the teachings of Jesus Christ, such as help the poor, feed the hungry, heal the sick ... I thought that was what Jesus said, over and over and over again." 

Morgan Wills, a doctor, identifies as politically independent and has never participated in a political rally before. But he's here now, because the proposal just seems reasonable and also because of the horrors he encounters as head of a Nashville clinic for the uninsured.

"I had a patient who had a gunshot wound and was scared to go to the emergency room,” he says. “He showed up in our clinic two days later."

He also describes how his own son had had an appendectomy last week and he's doing just fine, in contrast to a child of one of his clinic's patients. "He had the same exact situation, and they were scared to go to the emergency room. They waited, and [his appendix] burst. He was gravely ill," he says. "Examples like that remind me that though the proposal is not perfect, it is better for people to have some insurance."

As the session approached, purple-shirted advocates lined the hallway the legislators passed through, singing and clapping to "We Shall Not Be Moved." "We're fighting for Tennessee ... and we shall not be moved," they sang. 

When the session got underway, hundreds of Insure Tennessee supporters packed the room; it got so full an irate lobbyist sitting close to one of the doors kept leaning over and hissing, "It's too crowded!" whenever more activists tried to make their way in. 

Two Republican senators who backed the plan, Doug Overbey (a sponsor) and Richard Briggs, made their case to a committee composed of eight Republicans and a lone Democrat; their case largely being that this was not Obamacare, which they said over and over again.

"Now we have to address the 800-pound gorilla in the room. Is Insure Tennessee Obamacare? I can assure you, it is not," Sen. Briggs declared. 

Their sell was predictably pro-business Republican. They made market-friendly arguments, such as that a healthy workforce is essential to economic prosperity. They pointed out that many rural hospitals were at risk for closure due to the economic hit of treating the uninsured and noted that businesses might think twice about relocating to an area where their employees would not have access to a hospital.

"This is no free ride for the insurance-less," stressed Sen. Briggs, noting that participants in the program would have to pay premiums and failure to do so would make them ineligible. 

They assured their colleagues the plan would not cost Tennessee taxpayers, since it would be paid for by the federal government and hospitals—a major concession from that industry. 

Sen. Overbey explained that despite initial reservations, he'd come around and was convinced it was good policy for the state; that it would make Tennesseans healthier and grow the economy. His concerns were also assuaged by assurances from the governor and the Medicaid office that if either the federal government or the hospitals cut their funding, the state could opt out. 

"We may not trust the federal government, but we trust our governor," Sen. Briggs said.  

In his final appeal, Sen. Overbey described the plan as a "home run" that would help Tennesseans without raising taxes and ended with a plea. "Vote yes. If you vote no, it kills the conversation this year.” 

The string of nays rang out swiftly. The committee voted 6 to 2, with one abstention, to kill the plan rather than allow it to go to the next committee for discussion. The activists started a round of, "This little light of mine, I'm going to let it shine" and filed out of the room. 

Outside, as depressed activists milled around, Michele Johnson, co-founder and executive director of the Tennessee Justice Center, managed to come up with a hopeful message. "What happens now is, we take this democratic movement to every part of the state. We'll keep telling the truth. Just keep telling the truth."

A Gofundme campaign is raising money for Tracy Foster's operation. 

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