Last October, Republican Bill Haslam and Democrat Mike McWherter, opponents in the race for governor, appeared back-to-back in Nashville before a group of advocates for seniors.
Each candidate was asked if he would hold a Tennessee summit on aging if elected. Both said yes, and on Tuesday, Haslam, who won in November, delivered on the promise.
Actually, both the governor’s staff and the advocates for seniors kept the ball rolling, and Lipscomb University, which has developed a School of “TransformAging,” hosted the event. The Tennessee Governor’s Summit on Aging was a confluence of public, private and non-profit leaders addressing the issue from all sorts of perspectives.
Haslam spoke to an audience at Lipcomb’s Ezell Center about the need to provide the best services possible with limited resources. And in speaking to reporters afterward, the conversation quickly turned to the ever-rising costs of health care — the issue that will not only affect seniors dramatically in the future but is already wreaking havoc on state budgets across the country.
Haslam immediately went into the matter of federal entitlement programs, which are causing a lot of headaches for lawmakers in Washington. Haslam says the most important element of the issue is for leaders to recognize the problem.
“Leaders’ biggest job is to define reality,” Haslam said. “There is this interesting debate going on right now about: Should we cut back entitlements?
“If you take just the growth of entitlements and where we’re going, it’s going to consume more than what we bring in as a country now. There is not this definition of reality that says, ‘We can’t keep going the way we are now. We just can’t.’”
The dilemma is obvious. U.S. Rep. Paul Ryan, R-Wis., chairman of the House Budget Committee, offered a plan that meant big changes in Medicare and Medicaid, which was simultaneously considered both courageous and political suicide. Changing such programs is playing with fire, even if the changes would substantially cut the federal deficit.
“The big discussion is: Are we going to cut entitlements or raise taxes? That’s a Republican-Democrat back-and-forth,” Haslam said. “But I think it has to start with a clear message from everybody that the current path is not sustainable.
“The truth is we keep talking about non-sustainable paths. Our country and health care costs are on a non-sustainable path. There’s just no way we can keep having health care costs go up 10 or 12 percent a year. As a society, it just doesn’t work. It’s eating up the federal government’s money, the state governments’ money, businesses’, families’. We can’t keep going that way.”
Haslam said Darin Gordon, director of TennCare, the state’s Medicaid program, is good at coming up with creative ways to save money given the cards dealt him, such as addressing dual eligibility, where people qualify both for Medicaid and Medicare. But even creative solutions can be tricky.
“To do that, we have to go to CMS (the federal Centers for Medicare and Medicaid Services) and get a waiver from them, sometimes a year or year-and-a-half process, and sometimes even after that they say no to something that feels very logical to me,” Haslam said.
“So you have costs that continue to go up all the time. The federal government gets to call the tune on what’s covered and what’s not. But we pay part of it. So it’s like you get to order the meal, but I still have to pay for a third of it.”
Haslam brought up former Gov. Phil Bredesen‘s book, Fresh Medicine: How to Fix Reform and Build a Sustainable Health Care System. Bredesen’s view is critical of the remedy drawn up in the new health care law.
“One of the things I really agreed with in Governor Bredesen’s book is when he said he was disappointed with the health care plan and said we addressed the health care issue but we didn’t address the fundamental problem, which was that the rate of increase was something we couldn’t maintain as a country,” Haslam said.
When TennCare officials provided their budget proposals for fiscal year 2012, they took the approach that TennCare has tried to become part of the solution to the state’s budget issues instead of only a problem. Yet while TennCare has been beating the trend in Medicaid inflation, the agency projected a roughly 3.8 percent increase at a cost of $90 million because of medical inflation overall, enrollment and shifts in the TennCare population. Haslam had an opportunity as the budget process moved along to restore some TennCare cuts when federal funding errors had been found.
Haslam did not present any new ideas for controlling costs in the health care system on Tuesday, but his frustration with confronting the rising costs has been showing up in the governor’s remarks on various subjects recently, like college tuition. Haslam is lamenting that the state has to continually raise tuition because it has to pay for increases in the costs of health care.
So it was not surprising on Tuesday for the governor to look at various issues related to senior citizens and talk about health care.
State Sen. Lowe Finney, D-Jackson, one of the participants in the summit, believes issues facing senior citizens warrant creating a new state Department of Aging.
Finney, chairman of the Senate Democratic Caucus, has proposed legislation that would create such a department, although it has not gotten past the studying stage in the Legislature. Similar efforts to create an aging department preceded him.
“I believe when you look at the various constituencies who have a direct contact with the governor, one of the largest, fastest-growing sectors is the senior citizens population,” Finney said. “They do not have that direct contact with the governor by being the head of a department or a commissioner. … It just seems to me only fair that whenever you have that largest, fastest-growing group of people that they need to be included in that vision-making process.”
Haslam, however, said he does not see the need for a Department of Aging.
“We have 22 departments in Tennessee. That’s a lot,” Haslam said. “It would be easy to keep adding departments. My own view is we can take care of it out of the current structure.”
Finney sees good intentions coming from the Haslam administration.
“I think the governor is honestly trying to figure out where we are in terms of how we deliver services, and I hope once he has all the information he’ll feel comfortable going in that direction to have a department,” Finney said.
“One of the big issues is streamlining the services we have and making them easier to access. We need to make sure senior citizens get the best care most efficiently.”
Mark Cate, special assistant to the governor who was instrumental in getting the summit together, opened the program Tuesday.
“This is just the beginning. This is not the end,” Cate said of the effort to deal with senior issues. “You will hear back from us as we think about the next steps, ultimately to create a true public/private partnership for dealing with the aging issues in our state.
“Seniors are not only a stakeholder. They truly are a resource, and I know we will recognize that there is wisdom in those years.”