Stark federal choices harm Tennessee

More Tennessee hospitals could close if Congress allows enhanced health insurance marketplace subsidies to expire (Photo: Getty Images)

Former President Joe Biden is fond of quoting from his father, “Don’t tell me what you value. Show me your budget—and I’ll tell you what you value.”

Of course, our current federal government no longer budgets directly.  It stumbles through months at a time with extensions, continuing resolutions, and bills with large budgetary effect — but often not complete or even rational. Thus, it’s best to express the past several months of budgeting (everything from Trump’s One Big Beautiful Bill to the current government shutdown) as a simple but profound value choice.

If you only could choose just one temporary item to extend, which would it be: Trump’s tax breaks largely benefitting the wealthy and corporations, or the credits that help many middle class and poor Americans pay for health insurance?

The numbers from Tennessee make it clear the latter is the far superior choice. The Urban Institute examined how ending those credit subsidies would affect health insurance policies done through the Affordable Care Act marketplace. For Tennesseans the average annual net premium would jump from $145 to $608, even if persons switched to the lowest cost plan in the market. More than 600,000 Tennesseans get health insurance through the ACA. The Tennessee Justice Center estimates the ballooning costs will lead to an estimated 265,000 Tennesseans being forced to go without insurance — and the rest of us pay through increased costs when the uninsured find care only through emergency rooms.

Report: An end to ACA tax credits to increase uncompensated care costs in Tenn. by nearly one-third 

If the Congressional Republican majority closes its eyes to the effects of Trump budgeting, Tennessee could see one result in rural hospital closings. One recent analysis found that nine Tennessee hospitals are at risk of closure if the current budget policies prevail. The problem is nationwide, but Tennessee has the highest rate of rural hospital closures per capita. This problem is exacerbated by our long and nonsensical tradition of turning down Medicaid expansion. This failure of our state legislature has cost our state more than $27 billion and counting.

Compromise may be the currency of legislating, but the current congressional majority already has turned aside one reasonable compromise regarding extending tax breaks. Congressional Democrats proposed an amendment that would continue the lowered tax rates for people making less than $400,000 a year. Only those over that high annual income would see previous rates kick into place. As 60 percent of the Trump tax break extension money goes to that higher income group, the budgeting becomes better — and we thus could extend the health insurance subsidies benefitting everyday middle-income families. Republicans, including those from Tennessee, quickly shut down that reasonable compromise.

Our current batch of Republican senators and congressmen from Tennessee are toeing the Republican line and blaming Democrats for the shutdown, but contribute little to any resolution — other than bloviating about passing their plan and maybe they might get around to all those other matters.

The current federal stalemate and government shutdown is particularly problematic. Democrats want to avoid the coming crisis of health insurance costs crushing family budgets. Further, trusting the GOP is a real problem because of the Trump administration’s record of snubbing law and tradition, and refusing to spend certain monies already allocated by Congress. Republicans control the White House, Senate and House. This fall already Senate Republicans have used the “nuclear option” (changing the rules to negate the filibuster and allow a simple majority to prevail) to jam through a package of dozens of Trump judicial nominees. Presumably they could do the same to ram through their awful budgeting, but haven’t gone there yet.