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2014

Many Americans with existing policies

began receiving cancellation notices—

a revocation of a promise that Obama and

numerous other Democratic leaders had

made repeatedly for the previous four years:
growth of its Medicaid spending more

than double relative to neighboring
“If you like your plan, you can keep it.”
states. by the beginning of the brede-

sen administration less than 10 years
later, more than 1 in 4 Tennesseans

were on TennCare, and the program, in
democrat bredesen’s words, threat-

ened to “bankrupt our State” with a

$650 million shortfall. As a result, he expenditures accounted for only about
ordered the disenrollment of nearly one out of every 20 dollars in America’s Back to the Future

200,000 Tennesseans and cut benefits gross domestic product. Last year, they Tennessee already encountered these
for the rest.
were more than one out of every six. two problems of health-care access and

government picked up none of the tab budget-busting costs and attempted to
Cure or Placebo
in 1960, but now government is paying solve them in 1994 with TennCare—a
TennCare’s history cautions, then, a third of it, and government actuaries statewide expansion of Medicaid.

that early success does not indicate expect that eventually to rise to one one part of the ACA rollout that has
sustainability. The most important half, as baby boomers become eligible been comparatively successful was

questions about the ACA may be dif- for Medicare.
a similar expansion of Medicaid in

ficult to answer for years: Is it working? Additionally, Americans appear to participating states, such as Kentucky.
Is it addressing the two problems it set achieve less bang for their health-care by November 2013, more than 56,000

out to solve of access to health care and buck than most other advanced Western Kentuckians had enrolled via the
reducing the growth of medical costs?
societies where governments exert state’s Web site, 80 percent of them in

greater control over costs (see sidebar Medicaid. by the same date, fewer than
Access to Health Care
on page 112). Those who can afford the 1,000 Tennesseans had. Republicans in

After its horrendous start, the na- best American health care seldom find
the Tennessee general Assembly led by

tional exchange saw enrollment surge it inferior to that overseas, but in 2010 State Senate Speaker and Lieutenant
in december as the year-end deadline no one could dispute two facts: 1) mil- governor Ron Ramsey (R-blountville)

approached. The ACA was still not on lions of Americans had limited access to oppose the Medicaid option, and
track to reach the obama administra- health care; 2) the growth in Medicare governor haslam has voiced his res-

tion’s goal of 7 million by March 31, but and Medicaid costs threatened to de- ervations: “We don’t want to expand

those numbers were far better than the vour the federal budget: the Congressio- a system that’s not doing a good job
abysmal figures in october.
nal budget office (Cbo) projected that controlling costs... We want to end up

A worrying statistic has been the by 2035 health care programs and Social with something that’s not just Medic-
sparse enrollment by the young and Security would consume one out of ev- aid with lipstick on it.”

healthy. The Congressional budget ery six dollars in the American economy. Perhaps it’s only politics—or per-

office projections of the program’s Add in debt service, and the government haps it’s experience that drives goP
finances relied on 38 percent of enroll- would no longer have revenue to pay for reluctance. After implementation of

ments being between the ages of 18
anything else.
TennCare in 1994, Tennessee saw the

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