Lee’s Medicaid block grant proposal deemed ‘illegal’ by House chairman

Gov. Bill Lee speaks at the state Capitol on Sept. 16, 2019. (Erik Schelzig, Tennessee Journal)

Gov. Bill Lee’s application for a Medicaid block grant is drawing fire from a power chairman in the U.S. House, the Chattanooga Times Free Press reports.

“This is illegal and the Trump Administration does not have the authority to do this,” House Energy and Commerce Chairman Frank Pallone (D-N.J.) wrote on Twitter.

“I wrote to [Health Secretary Alex] Azar this summer reminding him HHS does not have legal authority to implement a block grant or per capita cap on the Medicaid program,” Pallone said. “While Secretary Azar has yet to respond to me, ignoring oversight letters from Congress doesn’t change the fact that block granting Medicaid is illegal.”

The Tennessee proposal has drawn praise from Republican Tennessee Sens. Lamar Alexander and Marsha Blackburn.

The details of Lee’s block grant application were unveiled this week, launching a 30-comment period before it is submitted to the federal government. Supporters say it can be approved without congressional oversight.

“Gov. Lee has reiterated that point throughout this process and it will be up to [the Centers for Medicare & Medicaid Services] to communicate what they are willing to accept during the negotiations,” said Laine Arnold, a spokeswoman for the governor.

Lee’s block grant proposal: What they’re saying

Gov. Bill Lee’s administration on Tuesday unveiled its Medicaid block grant proposal, kicking off a 30-day public comment period. Here’s a sample of how Tennessee news outlets are covering the news.

Tennessean:

Currently, the federal government provides about $7.5 billion to $8 billion annually to pay for TennCare. This funding increases or decrease as the need grows or shrinks, and the money is theoretically limitless if the state continues to operate TennCare in accordance with federal guidelines.

As proposed, Gov. Bill Lee’s administration’s plan would convert that funding into a “modified block grant,” giving the state government more authority over how this money is spent. Block grants are generally finite, raising concerns this money might run out, but the governor’s proposal asks the federal government to commit to providing more money if it is needed by the state in the future.

Chattanooga Times Free Press:

Lee’s proposals have already come under fire even before he made full details public.

“I think the issue is that when they say that they’ve created all these ‘savings’ for the federal government, that includes like the 220,000 children that were cut off even though tens of thousands of them were eligible,” said Michele Johnson, executive director of the Tennessee Justice Center, in an early September interview.

“Here’s the bottom line,” Johnson said. “The Trump administration has said they’re going to cut over a trillion dollars out of the [national] Medicaid program through block grants. The Lee administration says we’re going to be able to get all this money, an expansion of health care? The math doesn’t work out.”

_ The Daily Memphian:

Initially, the governor avoided answering how much the state could net through the block grant proposal. But after TennCare Director Gabe Roberts acknowledged the state’s “budget neutrality” figure is $2 billion, the governor conceded Tennessee could land $1 billion if the feds agree to the state’s entire proposal.

Lee couched that comment by noting the amount will depend on whether the feds place new service requirements on TennCare, which typically receives about $8 billion from CMS and about $4 billion from the state.

_ WPLN-FM:

Primarily, the additional money comes from a plan to split savings TennCare already generates with the federal government. Under its current waiver, Tennessee’s Medicaid program costs the federal government billions of dollars less than if it were just the open-ended federal benefit. Tennessee now wants to share those savings 50/50, which is expected to be a key sticking point in negotiations.

The block grant also envisions saving money by cutting red tape, like the periodic reapprovals of Tennessee’s waiver. Even when very few changes are made, the process takes nearly a year. Tennessee is asking for its new block grant proposal to be considered permanent.

TennCare wants to change a few rules that would ensure it’s the “payer of last resort,” particularly in cases where a patient also qualifies for Medicare.

_ The Associated Press:

The plan’s likelihood of ever being implemented, however, remains largely unknown. To date, no state has been given permission to rely solely on block grants to cover Medicaid expenses. The idea has been floated by Republicans for decades but never implemented, due to possible legal challenges and concerns that doing so would result in large spending cuts to the states’ most vulnerable populations.

Yet Lee remains hopeful, noting that support is growing under President Donald Trump’s administration and asserting that no services to the state’s indigent population will be cut. Tennessee’s GOP U.S. Sens. Lamar Alexander and Marsha Blackburn have also expressed interest in the plan, an endorsement that some say could help push the idea further along.

The Nashville Business Journal:

The 50/50 split Lee is pitching, as well as other aspects of the proposal, are subject to changes and negotiation once Tennessee submits a formal proposal to the federal Centers for Medicare and Medicaid Services.

“We think we have crafted a waiver that is going to really mitigate the risk that Tennesseans have and actually give us an opportunity to benefit from the efficiencies and the way that we run our program,” Lee said. “That benefit will give us an opportunity to provide enhanced services to our TennCare population … and eventually, for the same money, provide additional services to more people.”

While health systems have yet to comment publicly on Lee’s plan, Republicans in Congress had pitched a similar proposal in 2017 as their effort to repeal and replace the federal Affordable Care Act. At the time, more than 20 organizations, including the American Hospital Organization and the American Medical Association, came out against the proposal, which ultimately failed.

_ The Washington Post:

Tennessee is setting up the nation’s first test case of how far the Trump administration is willing to go to allow a state the “flexibility” that has become a watchword of the administration’s health-care policies.

If TennCare, as that state calls its Medicaid program, wins federal approval for its plan, it could embolden other Republican-led states to follow suit. It also almost certainly would ignite litigation over the legality of such a profound change to the country’s largest public insurance program without approval by Congress.

The Wall Street Journal:

If block grants catch on, the Trump administration could be successful in achieving the Medicaid changes congressional Republicans were unable to in their failed 2017 repeal of the ACA, also known as Obamacare. Tennessee’s proposal released Tuesday would be submitted to the Trump administration in November following a public comment period.

Under Tennessee’s draft proposal, the state would get a lump sum based on projected Medicaid costs. The grant would be adjusted each year for inflation. The federal government would increase its funding on a per capita basis when Medicaid enrollment eclipses the number used to calculate the state’s initial grant amount.

Sethi blasts Romney (and, by extension Hagerty) over refusal to endorse Trump

Republican surgeon Manny Sethi in a fundraising email blasts U.S. Sen. Mitt Romney for saying he won’t endorse President Donald Trump in next year’s election. Romney, of course, is a longtime friend and mentor to former Ambassador Bill Hagerty, who joined the Senate race last week. Sethi doesn’t mention Hagerty by name in the email blast, but points out that voters will have a choice between the “conservative outsider” and the “political establishment.”

Trump has endorsed Hagerty in the race. And Hagerty has left little opportunity unseized to sing the praises of the president. Tennessee Republicans have never quite warmed to Romney, who finished third in the state’s Republican presidential primary in 2008 (behind Mike Huckabee and John McCain) and second to Rick Santorum in 2012.

Here’s the full Sethi email:

From the beginning I have said that Tennesseans will have a choice between a conservative outsider, and the political establishment.

Romney himself came out in support of my opponent. One political insider supporting another. But, you know who Senator Mitt Romney won’t endorse? Our President.

Just last week, Mitt Romney came out and said he will not endorse President Donald Trump for re-election. Wow. This is the same guy that supported a regressive carbon tax, is the father of Obamacare, and did not want to reduce capital gains taxes. And now he refuses to endorse President Trump.

I personally support and endorse President Trump, 100%. He’s doing a great job curbing illegal immigration, defeating ISIS, and delivering tax breaks to the entire country.  He needs a second term to accomplish even more.

Send me to Washington to work with President Trump to make that happen. Let me take on the DC establishment and career politicians who won’t stand with our President.

 

New Nashville mayor’s transition team raises eyebrows

A  Tennessean report about Nashville Mayor-elect John Cooper’s transition team included several items that raised eyebrows. One was the selection as Greg Hinote, an aide to former Mayor Karl Dean, whose pro-development record ran counter to Cooper’s neighborhoods-first platform. The other was Victor Ashe, the former four-term Knoxville mayor and Republican state senator. Though it turns out there’s a pretty big caveat to the latter’s role in the transition.

Ashe, it turns out, retired after 20 years on the faculty of the Institute of Politics at Harvard University’s John F. Kennedy School of Government, where he has been involved in the biannual Seminar on Transition for Newly-Elected Mayors (this year’s version is scheduled for Dec. 3 to Dec. 5).

“I am happy to share with mayor-elect Cooper my experience in transition to the mayor’s office, issues likely to be faced in short term, and how to prepare for it,” Ashe said in an email.

Meanwhile, there has been great rejoicing among legislative Republicans about the defeat of incumbent Nashville Mayor David Briley. But it remains to be seen how long the lovefest between the GOP and the brother of U.S. Rep. Jim Cooper (D-Nashville) will endure.

Cooper trounces Briley in Nashville mayor’s race

Metro Council member John Cooper trounced incumbent David Briley to be elected Nashville’s next mayor. The result wasn’t unexpected, but the 39-percentage point margin came as a bit of a surprise.

Cooper is the brother of U.S. Rep. Jim Cooper (D-Nashville).

Here’s a release from the Cooper campaign.

NASHVILLE, TN – At-large-Councilmember John Cooper has defeated Mayor David Briley to become the ninth Mayor of the Metropolitan Government of Nashville and Davidson County. According to the Davidson County Election Commission, unofficial election results show that Cooper defeated Briley by a vote of 70 percent to 30 percent.

In a speech at The Nashville Palace, Mayor-elect Cooper thanked the voters and laid out plans on how to build a Nashville that works for everyone. 

Excerpts from the speech are included below:

As Mayor, I will work every day to continue to listen and learn. To put neighborhoods first and make sure that this Administration reflects the values of our city and her people in all of our actions. To restore trust that our people and their needs come first.

In the speech, Mayor-elect Cooper also spoke to the issue of fiscal responsibility:

I’ve been told that I care too much about the numbers. But if we don’t get the money right, we can’t get anything else right. Because in government, to care about finances is to care about people. That is how you make their dreams real.

Paying attention to the bottom line allows us to support people on the front line — our teachers, our police, our firefighters, our bus drivers, our paraprofessionals. And yes: teachers are the real developers we need to support. 

He also expressed gratitude to Metro employees and invited the entire city to come together and move Nashville forward:

And to the great people who work hard for Metro every day, I need your ideas and your help in the work to come. It is my job to support you in our work ahead. 

For everybody who voted for me, thank you. For everyone else, know that I will work every day to earn your trust and respect. This is a city for everybody. 

We’re going to have more growth in the next five years than in the last five years. Those new cranes are lifting up our skyline. We need to lift up our people with it. That is our challenge — using this prosperity to build a better, more livable city. This is the moment to make Nashville work for everybody. 

We started at two percent in the polls. Hundreds of volunteers and more than a thousand donors — from every district — got us here.

But this isn’t the end. I need all of your help. We must not waste this moment. Together, we will make a Nashville for everybody. Thank you!

Dunn won’t seek re-election to House in 2020

House Speaker Pro Tem Bill Dunn (R-Knoxville) presents school voucher legislation on May 1, 2019. (Erik Schelzig, Tennessee Journal)

Rep. Bill Dunn of Knoxville, the longest-serving Republican in the state House, says he won’t run for re-election next year. Dunn was the lead House sponsor of this year’s controversial school voucher legislation. He had already drawn a primary opponent.

“After the 2019 session was over, and we had passed Educational Savings Accounts legislation, as well as one of the most pro-life measures in the country, House Bill 1029, I decided it was the right time to conclude my public service on a high note,” Dunn said in a statement.

Here’s the full release:

NASHVILLE, Tenn. — State Representative Bill Dunn (R-Knoxville) today announced he will not seek re-election to the Tennessee House of Representatives in 2020.

Dunn currently serves as Speaker Pro Tempore — the second ranking member of the Tennessee House of Representatives. He recently was the acting Speaker of the House due to the resignation of the previous Speaker. Dunn was first elected to the General Assembly to represent the citizens of House District 16 in 1994, making him the longest tenured Republican House member now serving.

“After the 2019 session was over, and we had passed Educational Savings Accounts legislation, as well as one of the most pro-life measures in the country, House Bill 1029, I decided it was the right time to conclude my public service on a high note.”

Dunn said that he wanted to go ahead and make his plans known so that those interested in running for the seat could start making their own plans.

“I am grateful for the opportunity to serve the citizens of our community for the past 26 years as a member of the Tennessee House of Representatives. I have reached a point in my life where it is time for me to seek new challenges. I am not sure what my future holds, but I look forward to many new and exciting adventures.”

During his tenure, Tennessee students became the fastest improving in the entire nation across math, reading and science. In 2019, Dunn championed an initiative that establishes the Tennessee Education Savings Account Pilot Program which gives students and their families the opportunity to select the school that most meets their educational needs.

Additionally, Dunn has been an unwavering and passionate voice for the Right to Life. He has fought to strengthen Tennessee’s pro-life laws in recent years and has strongly supported initiatives to protect unborn children and their mothers.  This year, the legislature passed one of the country’s strongest pro-life measures, House Bill 1029, which restores Tennessee’s pre-1973 pro-life laws when the Supreme Court overturns Roe v. Wade.

Dunn was tireless in pursuing road improvements in the district, and he will leave office with major improvements to Emory Road in Powell, Highway 33 in Halls, and the I-640/Broadway interchange in Fountain City.

Dunn and his Republican colleagues have also cut more than $700 million in taxes since 2011, and they have supported a business-friendly environment that has led to statewide unemployment rates remaining near historic low levels.

“I will be leaving office with our state in a stronger position than when I first came to Nashville,” said Dunn. “We have vastly improved our education system, our state is ranked number one in fiscal responsibility, and, because of the conservative leadership, we continue to attract quality jobs.  I appreciate my colleagues for their friendship and for their dedication to the citizens of Tennessee. I represent the best people in the state and thank the constituents of the 16th House District for the opportunity they have given me to serve them and the great state of Tennessee.”

Bill Dunn is Speaker Pro-Tempore for the 111th Tennessee General Assembly. Dunn is also a member of the House Calendar & Rules, Education, Government Operations, and Naming, Designating & Private Acts and Transportation Committees. He is also a member of the House Curriculum, Testing, and Innovation, and the House Infrastructure Subcommittees, as well as the Judiciary & Government Subcommittee of Joint Government Operations Committee. Dunn lives in Knoxville and represents Tennessee House District 16, which includes part of Knox County.

Hagerty camp touts McConnell endorsement, says he’s under attack by ‘liberal media’

Bill Hagerty attends the Tennessee Republican Party’s Statesmen’s Dinner in Nashville on June 15, 2019. At right is U.S. Sen. Marsha Blackburn (R-Brentwood). (Erik Schelzig, Tennessee Journal)

Newly announced U.S. Senate candidate Bill Hagerty says in a fundraising appeal that he’s been endorsed by Senate Majority Leader Mitch McConnell and that he’s already under attack by “Washington Democrats and their media allies.”

Hagerty had long been expected to get into the race, especially once President Donald Trump announced his endorsement while he was still U.S. ambassador to Japan. Vanderbilt surgeon Manny Sethi had previously been the only major Republican in the race to succeed retiring Sen. Lamar Alexander (R-Maryville).

Hagerty’s formal entry into the race hasn’t stirred too much attention in the national media. For example, the Washington Post and New York Times both used the AP’s account out of the Nashville and haven’t written anything further. Politico wrote its own account.

The Tennessean ran what it deemed an exclusive interview with Hagerty on the day of his announcement, but the campaign had been scooped in declaring its launch by enterprising Nashville Scene reporter Stephen Elliott, who spotted Hagerty’s Federal Election Commission filing earlier in the day. Otherwise, there’s not been a ton of media attention — good or bad — to Hagerty or the Tennessee Senate race.

Nevertheless, the Hagerty email calls it critical for the candidate to post a large fundraising haul to “prove the liberal media talking heads wrong.”

Here’s the email from the Hagerty campaign:

Friend,

Bill Hagerty announced his campaign for U.S. Senate this week, and he’s already been endorsed by President Trump and Senate Majority Leader Mitch McConnell.

Join President Trump and Mitch by making a generous donation right now.

Trump and Mitch know that Bill Hagerty is a strong conservative who we can count on to stand up to the Democrats’ radical socialist agenda. And that’s why Washington Democrats and their media allies are already attacking Bill.

We have to send a message that we have his back. It’s CRITICAL that Bill posts the biggest fundraising haul possible to prove the liberal media talking heads wrong.

SEND A MESSAGE TO THE LIBERAL MEDIA

[…]

Thank you for your support.
Team Hagerty

UPDATE: The Sethi campaign is denouncing the McConnell endorsement. Here’s the release:

NASHVILLE, Tenn. – Republican Senate candidate and conservative outsider Manny Sethi’s campaign released the following statement on Senate Majority Leader Mitch McConnell’s endorsement of Ambassador Bill Hagerty for Senate.

“Today, Mitch McConnell–the same guy who brought us runaway spending, failed to repeal ObamaCare and not building the Wall–joined Mitt Romney today, endorsing moderate Ambassador Bill Hagerty,” said Chris Devaney, Campaign Chairman and Senior Advisor.

“Tennesseans want a conservative outsider like Manny Sethi—and we don’t want Mitch McConnell, Mitt Romney, or any other member of the DC Establishment ‘Death Star’ telling us who to vote for.”

Tennessee GOP wades into Nashville mayor’s race

The Tennessee Republican Party is sending out mailers targeting Nashville Mayor David Briley, who is in a tough re-election battle against Councilman John Cooper. The runoff election is on Thursday.

The mailer seems to align Briley to the so-called Squad in Congress and attacks the mayor for his efforts to limit local law enforcement cooperation with federal immigration agents. Briley’s recent executive order has also been criticized by new House Speaker Cameron Sexton (R-Crossville). The mailer does not mention Cooper.

The reverse side of the mailer endorses Steve Glover’s at-large Council bid.

Glover has announced plans to sue to block Briley’s immigration policies.

 

National Journal looks into why Dems ‘can’t get it together’ in Tennessee

Democratic Senate candidate Phil Bredesen speaks at a rally in Nashville on Aug. 20, 2018. (Erik Schelzig, Tennessee Journal)

The National Journal is taking a deep dive into why Democrats have largely failed to make recent gains in Tennessee. The piece is written by reporting fellow Kirk Bado, who once interned in the state Capitol bureau for The Tennessean before going to graduate school.

The article examines why Democrats couldn’t make inroads in the 2016 election despite popular former Gov. Phil Bredesen being on the top of the ticket in the U.S. Senate race.

Bredesen failed to ride the blue wave, losing by 11 points as he carried only two counties, despite the same kinds of demographic changes that have helped other Southern states turn shades of purple. According to current projections, 30 percent of Tennesseans will be minorities by 2030. Given national trends of college-educated voters swinging further to the left, and Tennessee could be on its way to swing-state status; instead, its slate of federal officeholders are as red as those in Mississippi and Arkansas.

Democrats were right back where they started the decade: on the outside looking in.

Bado delves into Tennessee’s transition from conservative Democrats to conservative Republicans, dating back to favorite son Al Gore’s losing his home state in 2000 and the state income tax battles that occurred before and after that momentous election.

While a rightward trend since then should present an opportunity for Democrats, it hasn’t worked out that way, Bado writes:

In theory, Democrats should be well positioned to compete in Tennessee as Republicans shift further to the right. The population has increased by nearly 7 percent since 2010 on the backs of the rapid growth of the tech and health care industries, and a growing nonwhite population.

So what’s to be done? Activists like Charlane Oliver formed Equity Alliance want drastic action.

“The Democratic Party needs two things: They need a backbone and grow some balls,” she said. “Because the Republicans don’t fight fair, and you cannot bring a knife to a gunfight.”

State party chair Mary Mancini, who was elected to her third term in January, admits that her party has struggled to build a bench, failed to make Tennessee competitive, and acknowledges the dire straits the party faces. Yet she promised that Democrats are rebuilding in the state.

“We’re building a Democratic Party for the future, not just the elections coming up next November,” she said.

When asked what she will do differently to change Democratic fortunes, she seemed taken aback by the question, pausing for several silent seconds.

“That’s a really good question,” she finally said. “That’s something I’m going to have to think about a little bit.”

Read the full article here.

Voucher sponsor Bill Dunn draws GOP primary challenger

House Speaker Pro Tem Bill Dunn (R-Knoxville) presents school voucher legislation on May 1, 2019. (Erik Schelzig, Tennessee Journal)

Rep. Bill Dunn, the lead House sponsor of this year’s school voucher bill, has drawn a primary challenge from Patti Bounds, a former teacher and Knox County school board member, Knox TN Today reports.

“I opened the bank account today,” Bounds told the publication.  “And now it feels real.”

Bounds opposes the “Education Savings Account” measure enacted at first-year Gov. Bill Lee’s behest. Dunn has been a longtime supporter voucher proposals. He has served in the General Assembly since 1994. He currently serves as speaker pro tem, the ceremonial No. 2 position in the House.

It’s on! Bounds vs. Dunn 2020

Dunn is the second incumbent to draw a primary opponent over the voucher issue. Freshman Rep. Tom Leatherwood (R-Arlington), who voted for the education savings account bill, has drawn a primary challenge from Lee Mills, a former Shelby County GOP
chairman who opposes the measure..