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Bartering for Health Care

My state, Tennessee, has the highest rate of hospital closures per capita of any state in the nation. Meanwhile, neighboring Arkansas — which has expanded Medicaid under the Affordable Care Act — has experienced zero hospital closures since expansion.

Those were the findings of a recent University of North Carolina study.

The Tennessee Justice Center reports that some 300,000 Tennesseans would benefit from access to affordable health coverage through Medicaid expansion. Yet Tennessee remains one of about 16 statesholding out on accessing these federal funds.

Because of a commitment from the Tennessee Hospital Association, expanding Medicaid would cost Tennessee taxpayers exactly $0 — while actually returning federal tax dollars to the state.

The state’s House of Representatives created a task force on health care in 2016 and determined that the state did need to improve access to care. Governor Bill Haslam even proposed a Medicaid expansion planback in 2015 and made at least some effort to advance it in subsequent years.

Free federal money. A Republican governor pushing expansion. A House task force that finds the state needs to do more. A plan that provides expanded access to coverage at no cost to the state’s general fund… Surely, Tennessee is now on the verge of passing Medicaid expansion, right?

No. Instead, lawmakers passed legislation that took effect on July 1 allowing uninsured patients to barter goods or services in exchange for health care.

So, if you’re famous for the tomatoes in your home garden, you can ask your doctor if she’ll accept them in exchange for a routine office visit. Need a minor surgical procedure? Maybe you can barter your social media skills with the surgeon and see if that’ll cover the cost.

Of course, if you need treatment for cancer or heart surgery, you could end up offering the doctor your house or small business in exchange for the life-saving treatment you need.

After calling several physicians in locations around our state, I’ve yet to find any that plan to accept bartered goods or services as payment.

The Tennessee plan for health care access is far from healthy. We can do better than offering an 1800s solution to a 2018 challenge.

The Tennessee plan highlights the importance of holding legislators accountable everywhere — and advocating for Medicare for All, to make sure no other states return to the days of bartering for something as important as health care.

Even as Arkansas and Kentucky experience huge successes with expanded Medicaid, our state continues to leave dollars on the table and hundreds of thousands of people without access to affordable coverage.

While 10 rural hospitals have closed in our state in recent years, legislators are busy suggesting citizens offer chickens to providers to get the health care they need. Ironically, these same legislators all have access to taxpayer-funded insurance. They certainly don’t have to barter for the care they and their families require.

Perhaps the new legislative health plan should be based on bartering for care — let’s say lawmakers should trade good laws for their health coverage. Since Tennessee legislators seemingly lack the ability to pass effective legislation, such a plan would leave most of them with no care at all.

Sadly, that’s exactly the situation nearly 300,000 Tennesseans — and millions of Americans — face every single day.

Andy Spears is the executive director of Tennessee Citizen Action, the state’s leading consumer advocacy organization and an affiliate of People’s Action.

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