Public pressure pushes health care to top priority

It’s GOP’s issue to solve with new governor, supermajorities

Friday, January 4, 2019, Vol. 43, No. 1
By Zack Barnes

Bill Lee waltzes into the governorship later this month with more goodwill on his side than most politicians have the right to expect.

The Republican, who takes the reigns Jan. 19, is inheriting a state with an unemployment rate under 4 percent, an improving education system, companies such as Amazon bringing in thousands of jobs and an approval rating of 57 percent, a Vanderbilt poll taken in December shows.

Making the transition even sweeter, the new governor will enjoy a politically affable Republican supermajority in both houses of the General Assembly, including party leadership expected to shepherd the Williamson County businessman in his first elected position.

Of course, Republicans don’t always agree, and the small band of Democrats will be vocal on major topics such as education and health care. Again, with no governmental experience, Lee will have to quickly learn how to navigate a legislative session with some weighty issues on the agenda.

He says he’s interested in criminal justice reform, including reducing recidivism. On immigration, he and his wife have worked with refugees, and he has said, “For every citizen of this state, I want them to believe that we are a state that wants them to be successful, that wants them to be part of this community.’’

That stance may well clash with members of his own party, including President Trump.

Immigration measures might create some conflict between Gov. Bill Lee – he will be sworn in Jan. 19 – and GOP legislators, but other disagreements should be rare.

-- Ap Photo/Mark Humphrey

As for health care, the public’s mood is shifting, the same Vanderbilt poll shows 66 percent of Tennesseans want to see Medicaid expanded, something Lee repeatedly said he is against throughout his campaign for governor. Republican lawmakers have made it clear they share that opinion.

“The one worry Bill Lee must deal with is health care, which has risen in importance to Tennesseans,” says Vanderbilt’s Josh Clinton, co-director of the poll. “Although the two are related, health care now takes precedence above the economy to voters here.”

Another area of possible contention is in K-12 education. The state is facing a bubbling of resistance to Tennessee’s annual testing after years of the troubled TNReady assessment.

“Decisions relating to leadership talent at the Department of Education are among the most important Governor Lee will be making for his administration,” says SCORE CEO and President David Mansouri. SCORE, which stands for State Collaborative on Reforming Education, has usually been closely aligned with Haslam’s Department of Education.

“The next commissioner will need, among other qualities, a track record of driving student-focused policy to deliver greater student achievement, team- and relationship-building experience, and strong communications skills for working with educators, policymakers, and the public.”

New kid on the block

Coming from outside the world of politics, Lee will have to learn how to work with and build relationships with the General Assembly. With 99 members in the House of Representatives and 33 in the Senate, there are a lot of relationships to be built. Fortunately for Lee, the Speaker of the House and Lt. Governor will be there to guide him. Unless something drastic happens, fellow Williamson County resident Glen Casada will become the next Speaker of the House.

Casada

Casada would take over for Beth Harwell who opted not run for reelection to make an unsuccessful bid for governor. Lt. Gov. Randy McNally’s 40-year political career will be a steady hand for the governor-elect.

Lee’s legislative supermajority includes 28 Republicans in the Senate (there are 33 total seats), and 73 Republicans occupying most of the 99 House seats. Expect the new governor to be more focused on different factions in the GOP than dealing with the Democratic minority.

There will be 27 new legislators coming in to the House, 20 of them are Republicans and seven Democrats. In the Senate, there are four incoming senators, with three of them being promoted from the house, evenly split among the parties.

On the Democratic side, Memphis Rep. Karen Camper has been elected as the minority leader. She becomes the first African American to lead the Democrats in the House. She joins presumptive speaker Glen Casada as the newest leader of their respective parties.

Harwell’s advice

“It’s very important for our governor to have a strong working relationship with the legislature, especially because of the way our state Constitution sets up the power balance between the legislature and the governor,” says outgoing Speaker of the House Beth Harwell. “It only takes a simple majority to override a governor’s veto, so it’s key that the governor is able to work with the legislature to outline his priorities and make sure that everyone is on the same page.”

While Lee will come into office with his own agenda, so does each and every member of the General Assembly. “I think Gov.-elect Lee has laid the groundwork for success by traveling the entire state and going into every district,” Harwell adds. “Each member’s district is different, and each member has different goals that their district wants them to accomplish, so it’s important that the governor keep that in mind.”

There are many areas Lee will focus on during his first year in office. Some of those will not require legislative approval, but many of the items will. As he takes office, he will be facing many issues that will need quick and efficient solutions.

Education in the spotlight

McQueen

Under the leadership of Candice McQueen, who was appointed at the start of 2015, the Department of Education has seen the testing fiasco mar the on-the-ground work to improve literacy, expand CTE education, and build relationships with teachers that other commissioners have had trouble doing. With the new administration, Lee has the power to pick what he wants the education department to focus on. No matter who leads the department, that person must be ready to take ownership of state assessment testing and come up with a plan to make it run smoothly.

The Commissioner of Education will have to be ready to take helm of an error-filled yearly state assessment. Lee says he wants to reduce “our testing burden with fewer and better tests.” That could create an unlikely relationship with the liberal leaning teacher union.

Brown

Beth Brown, president of the Tennessee Education Association, agrees with Lee on his education priorities. “Based on Governor-elect Bill Lee’s statements during the campaign, I believe we have a lot of common ground around issues of reducing the burden of high-stakes testing, improving career technical education programs, increasing respect of the teaching profession and giving teachers more freedom to teach.”

Specifically, when it comes to yearly assessment, TEA leadership says the organization is ready to work side by side with the newly-elected governor.

“TEA supports Lee’s statements on having a transparent and meaningful review of the issues with TNReady and how the state can improve on how student and teacher performance is measured,” Brown adds.

Other than testing, the commissioner and the governor must decide where the state is heading on education. When Bill Haslam took the reins from Democratic Gov. Phil Bredesen, the state had been awarded a Race to the Top grant from the Obama administration to spur reform and innovation.

Haslam’s legacy in the area of education reform is known nationally as one of the fastest improving states. But on election night, Lee stirred controversy by saying that, “Despite the steady improvement that we’ve had over the last few years, Tennessee schools are still at the bottom of schools nationwide.”

After the education news site Chalkbeat picked up the story, Lee’s campaign said that he misspoke and meant the “bottom half” of school nationwide.

With the state’s improving education landscape, there is still more that can be done. “There are many important Tennessee education issues on the horizon, some of which call for a smart and steady approach and some of which require innovation,” says SCORE’s Mansouri. “Examples of smart and steady include maintaining high expectations for students, administering a successful statewide assessment this year and every year, and holding schools and districts accountable for serving all students well.”

Lee has talked about the need for more focus on getting students ready for the workforce. As the chairman of Lee Company, founded by his grandfather, he has created programs to train employees to work in the plumbing and electrical trades. He wants K-12 schools to do more of that work.

Mansouri thinks that’s an issue that will need work. “We think there is room to be innovative in what will be a new area of focus for Tennessee in better aligning efforts between K-12 education with higher education and workforce needs. Tennessee is in a good place to develop a reputation as a pioneer in better preparing students to find the right routes to postsecondary education, careers, and opportunity.”

Lee has also been an outspoken proponent of vouchers for school choice. While attempts to pass vouchers over the last few years have failed, the legislature is changing. With many more new members joining the General Assembly, and with stronger support from Lee than from Haslam, this could be the year when a voucher bill passes.

Lee has hired two top staffers from voucher supporting organizations. Brent Easley, from education reform group 50CAN, has been hired as legislative director while Tony Niknejad, formerly of American Federation of Children, has been appointed policy director. Niknejad did a stint on Lee’s campaign before his appointment to Lee’s office.

Health care

Johnson

Thirty percent of Tennesseans polled in December said health care is the top priority, while 20 percent listed it as the No. 2 issue. More than half of Tennesseans see health care as a top issue for themselves and their families.

That means that health care is one of the biggest issues that the newly elected Governor will face.

“Gov. Lee is taking office amid huge health care needs for our state,” says Tennessee Justice Center CEO Michelle Johnson. The Center has pushed for Medicaid expansion. “Eleven hospital closures with more on the way, an addiction epidemic, and a rise in commercial insurance premiums. These are urgent needs that require serious investment.”

Utah, Nebraska and Idaho recently voted to expand Medicaid in the November elections. With Tennessee not following that trend, Lee must come up with a different solution. “Little can be done to improve – or, in rural areas, even to maintain – health care in Tennessee unless we join the growing majority of states that make full use of available federal Medicaid dollars,” Johnson adds.

Keckley

“Most other GOP states have figured out how to effectively garner and use the federal funds – $1.4 billion per year in Tennessee’s case – by designing their own alternatives to simply expanding Medicaid. We ought to be able to do the same.”

The state will be looking to other options to improve health care for Tennesseans, and there are some suggestions, says Nashville-based health care analyst Paul Keckley.

“If the legislature is reluctant to expand Medicaid, a combination of systemic reforms need consideration,” he says, including reducing emergency room use by expanding scope of nurse practitioners, aggressive medication management, integrated health and social services, bundled contracts with hospitals and more accountability of Medicaid plans.

The starting point, Keckley says, is “educating the state legislature, employers and the Tennessee electorate about options and potential systemic reforms that could reduce per capita costs and improve outcomes. Regrettably, misinformation about health care is a major challenge.”

As Tennesseans wait to hear Lee’s solutions on health care, the results from the Vanderbilt poll show the state is ready for a major overhaul.

“When Gov. Lee has an opportunity to look at these realities, we are hopeful he will find a sensible path forward,” Johnson says.

Criminal Justice reform

Lee sees criminal justice reform as a top priority for his administration. Such reform can come in different forms, but one area Lee wants to focus on is recidivism. “With a state prison recidivism rate of nearly 50 percent that’s even higher in most local jails, the real question is what doesn’t need to be reformed,” says Justin Owen, president and CEO of The Beacon Center, a free-market think tank in Nashville.

“Our system is failing on both the front and back end. We need to reduce the school-to-prison pipeline in our juvenile system. We also need reforms that divert low-level, nonviolent offenders into treatment if they suffer from mental health or substance abuse problems. This will save our prisons for those we’re afraid of, not those we’re mad at.”

Sharp

Lowering the recidivism will take some policy changes. “I think Governor Lee can look to the federal First Step Act as a guide to reducing recidivism,” says Kevin Sharp, the managing partner of Sanford Heisler Sharp’s Nashville office and former U.S. District Court Judge. The First Step Act, which was signed into law by President Trump in December, gives more flexibility to judges when it comes to sentencing and resources to reduce recidivism.

“The problem is that those previously incarcerated have to come out with skills to join the workforce and employers willing to hire them. Without those two elements the pull back toward criminal conduct as a way to survive is too compelling. The previously incarcerated have to be integrated back into society.”

Like on the federal level, the push for criminal justice reform has bipartisan support, bringing organizations like the Beacon Center and ACLU together. “ACLU-TN is a founding member of the nonpartisan Tennessee Coalition for Sensible Justice, says Hedy Weinberg, executive director of ACLU-TN. “Other founders include the Beacon Center of Tennessee, the Tennessee Association of Goodwill Industries, the Tennessee County Services Association, and the Nashville Area Chamber of Commerce.

Owen

“Together, we advocate for reforms that enhance public safety, promote rehabilitation, re-entry and workforce readiness, save taxpayer dollars, and improve transparency and accountability.”

Sentencing reform is one of the areas that will have bipartisan support. “The most pressing reforms need to be reduction in mandatory sentencings and sentencing enhancements that don’t have a relationship to the reason for the enhancements,” Sharp says. “Drug Free School Zone enhancement is the classic example.” Sentencing reform is not something that can be done overnight.

“Sentencing reform,” adds Beacon’s Owen, “will require changes to state law and will take longer to achieve, but work can be done right away to get the ball rolling in the right direction.”

Reforming the bail system has broad bipartisan support. ACLU-TN wants to “reform the money bail system to reduce the number of people sitting in jail pre-trial simply because they cannot afford to pay bail,” Weinberg explains. “At the same time, local jail facilities are also struggling to cope with incarcerating so many people – nearly 30,000 as of June 2017, according to the Tennessee Department of Corrections. Nearly half of those individuals had not been convicted of a crime and were locked up awaiting trial.”

The Beacon Center is also pushing similar reforms. “Going forward, our bipartisan coalition will continue to push for reforms to our bail system so that low-level, non-violent offenders can return to work and provide for their families while they await trial, and so that dangerous offenders can’t just stroke a check to get out on bail,” Owen says.

Some of the reforms can happen without legislation such as fully funding diversion programs. “Many things that need to be addressed can be done via executive order or just through better enforcement of existing law and proper allocation of resources,” Owen says. “Legislation isn’t necessarily required to create better diversion programs for mental health and substance abuse disorders, for example.”

Rural Tennessee

While on the campaign trail, Lee made rural development a priority. In an editorial in the Tennessean in June, Lee wrote that his first legislative plan as a candidate was for rural Tennessee.

“The plan is called my Roadmap for Rural Tennessee, and it highlights four key areas that leaders in Nashville and across the state can do to improve the way of life in rural areas,” Lee wrote.

The Governor-elect wants to get rural Tennesseans back to work, support innovation, address the opioid epidemic and partner with faith-based organizations.

Winters

Some of the issues facing rural Tennessee appear to be similar to those in urban areas. Todd Winters, dean of the College of Agriculture and Applied Sciences at the University of Tennessee Martin, wants Lee to see a focus on education, health care, farmer assistance and broadband. “The issue I worry about the most is diminished health care in our rural communities.

“Every year, here in Tennessee, another rural hospital or two close down. This not only negatively affecting the health of citizens who currently live in these rural areas, but also diminishes our attempts to attract new industries to our rural communities.”

But there are other needs, as well, Winters says. Rural students are not prepared for college, there is still too much red tape for farmers, there’s a trade war with China and a lack of rural broadband to drive innovation. Addressing those would be huge for rural residents.

There are things that are working. “Cooperative Extension, through the University of Tennessee and Tennessee State University, is strong and has historically played an important role in helping our farmers and rural communities in areas as diverse as diabetes prevention to identifying the best varieties of soybeans to plant,” he adds.

Winters says there are a few other items that could be expanded or fixed. “Our highways continue to be the major conduit for our agricultural products. Here in West Tennessee, completion of I-69 and the development of the Cates Landing Port would be extremely helpful to our rural communities and farmers.”

And, he says, continuing programs from previous administrations should continue. “I would like Governor Lee to continue and expand on some of the higher education programs, such as Tennessee Promise and Tennessee Achieves, initiated under the Haslam Administration. An educated workforce is a stronger workforce.”