Editor's note: This is the last post from the Nashville Health Care Council's 2014 Leadership Health Care Delegation to Washington. Click here for other entries from this year and past visits.
Attendees of Leadership Health Care’s 2014 Delegation to Washington were treated to a keynote speech by John Harris, editor in chief of Politico. Co-founded in 2007 by Harris, Politico has developed a reputation as the go-to source for nonpartisan, in-depth coverage of D.C. politics. Harris spent two decades covering politics at The Washington Post and is the author of “The Survivor: Bill Clinton in the White House,” which was a New York Times bestseller.
The delegation of 100 LHC members heard spirited remarks from Harris on the current political and media climate in Washington. In this video, he took a few moments to further discuss health care’s role in recent and upcoming elections, including an apparent upswing in Republican chances of regaining control of the Senate.
Photo Keith Mellnick
Roll Call suggests the junior senator may be looking at the statehouse:
“Sen. Corker is sometimes very frustrated with the process in the Senate, he is someone whose mindset is executive oriented,” one Tennessee GOP operative said. “He’s got an impressive private sector background and he’s used to getting things done, and that is the antithesis of the Senate.”
While panelists at Wednesday's Nashville Health Care Council Wall Street analysis event had plenty to agree on — the need for Medicaid expansion, the likelihood of further hospital and managed care consolidation and the very low chance of an ACA repeal — one topic had the panel divided.
Led by Community Health Systems Chairman, President and CEO Wayne Smith, the discussion ranged from perception to prediction, but the panel of analysts were not in consensus about a long-term "doc fix," a way to better control what physicians are paid by Medicare. While Congress has continued to kick the can in regards to replacing the Sustainable Growth Rate adopted in the late 1990s, each short-term postponement of physician pay cuts has heightened the financial need for a long-term solution. (Click here for some good background from The Washington Post.)
While local analysts Whit Mayo of Robert W. Baird and Frank Morgan of RBC Capital Markets told the event's audience that a permanent solution was likely — Morgan said that, if anything actually gets done in D.C. on this issue this year, it will be a long-term plan — Credit Suisse's Ralph Giacobbe and Bank of America Merrill Lynch's Kevin Fischbeck disagreed.
Fischbeck predicted only a 20 percent likelihood of a long-term fix, because it is politically easy to continually pass the small bills and Giacobbe said political gridlock will continue to be too strong to allow for a real solution.
A push by House Republicans to compel the state’s 11-member congressional delegation to meet with state lawmakers is falling short, according to GOP lawmakers.
Only one of Tennessee’s two U.S. Senators and none of the state’s nine Congressmen have responded to a requests by House Speaker Beth Harwell to meet with the House of Representatives, according to the speaker’s office.
“We could have tried harder as a body,” Rep. Judd Matheny, R-Tullahoma, a tea party conservative, told Republicans in a caucus meeting Tuesday after the opening session.
Matheny in October led a push in a 31-16 secret ballot vote of the House GOP Caucus to bring the delegation to Nashville and provide more accountability of federal lawmakers on issues like health care, states’ rights and personal liberty.
Matheny has blamed U.S. Sen. Lamar Alexander for the session not coming together, according to the Knoxville News Sentinel.
Alexander’s office was the only one to respond to requests for a bilateral session, according to Harwell’s press secretary. A letter from the senator dated Jan. 2, he pointed to the logistical challenges of making the meeting happen, but said he has talked to lawmakers individually.
Matheny, the former speaker pro tempore who lost favor in the caucus after he voiced desire to challenge Harwell in 2012, said he didn’t want to start the year out with disparaging words but said he wants the caucus to reach out to the delegation again.
“All you can do is invite them,” said GOP Caucus Chairman Glen Casada, a top ranking Republican to the caucus. “That’s all you can do.”
“All we hear from Sen. Lamar Alexander is crickets…again. When issues back home arise, Sen. Alexander refuses to step in and fight to get results. This affects families and their livelihood and is happening in Senator Alexander’s backyard, in his home town, yet we haven’t even heard a peep out of him,” says Representative Joe Carr.
From Tom Humphrey:
Gov. Bill Haslam is working with Tennessee congressmen to assess the feasibility of using state government resources to reopen the Great Smoky Mountains National Park and three other areas closed by the partial federal government shutdown, a spokesman said Thursday.
Just over half of Tennessee’s state agencies will feel some impact if the partial shutdown of the federal government stretches on for more than 10 days, according to the governor’s office.
The state health department would have to reduce staffing for its Women, Infants and Children program after 10 days, and the issuance of handgun permits and commercial driver licenses with hazmat endorsements would be affected due to required background checks, according to the administration.
As Gov. Bill Haslam hinted at yesterday, the Department of Human Services expects a long-term shutdown would mean a shortage in federal funds for food stamps, which would require the department dip into state funds. Payments to managed care organizations under the Medicare program could also be "distrupted," according to the governor's office.
The state’s Economic and Community Development Department would see delays in reimbursements for federally-funded programs, and if the shutdown persists, infrastructure grants to community could be impacted, the state reported.
Eleven other agencies said they expect no impact by the shutdown. Here's the full rundown for all state agencies, per the governor's office.
Federal Government Shutdown Summary
No impact: 11 departments
Some impact: 11 departments (Only if shutdown is longer than 10 days)
Significant impact: 1 department
Finance and Administration
Intellectual and Developmental Disabilities
Some federally-funded food programs may be affected if shutdown lasts longer than one month
Commerce and Insurance
Consumers needing help with the exchange may not be able to reach federal call center staff. This may cause a significant influx of calls to our Insurance consumer assistance section. Additionally, (if shutdown is lengthy) Medicare payment to Tennessee MCOs may be disrupted.
Economic and Community Development
Reimbursements may be delayed for federally-funded programs. If lengthy, grants to communities for infrastructure will be affected.
Impact on technical assistance. If lengthy, funding to districts may experience delays.
Environment and Conservation
Slower review of permits that require federal review and slower processing of federal grants.
WIC (Women, Infants and Children) program can only sustain a shutdown to approximately October 10th. A prolonged shutdown could affect personnel as much of the federal funding Health receives covers administrative costs.
Labor and Workforce Development
If longer than 7-10 days, OSHA would need to be funded with state dollars. If prolonged shutdown, staffing would need to be adjusted.
Mental Health and Substance Abuse Services
Funding available for the next three months. If prolonged, federal funds would end by approximately January 2014.
Weekend drills and annual trainings will not be conducted. Students who are in schools will be recalled. Monthly pay may be affected depending on length of shutdown.
[nothing listed by Haslam administration]
Safety and Homeland Security
Possible impact on the issuance of handgun permits and commercial driver licenses with hazmat endorsements due to background checks.
SSA and SNAP programs can only sustain themselves for a limited period without federal funding. Federal funds would expire within 10 weeks, with some variations and some state funds still remain. SSA indicated that they would restore any state funds that are used to cover FFY 14 expenses. DHS would need to make staffing adjustments downward according to funding streams.
While Gov. Bill Haslam expects reports from his commissioners by day’s end detailing how a pending federal government shutdown would affect Tennessee, he said Congress' considering of such a move is the wrong thing to do.
“Let me say this, I don’t think it’s an appropriate action for the federal government to have gotten to this point,” said Haslam when asked if "this is an appropriate action for the House Republicans to be taking."
The governor said, “I’m one of those who believes the government has to quit spending way more than it’s bringing in, but this is not the way to do that. Just to have an arbitrary shutdown in government that’s going to impact services, like I said in a non-discriminant way, is not the way to do it.”
If a spending plan is not passed by midnight Monday, federal government agencies and programs considered non-essential will close.
Locally, Haslam said the state is worried the shutdown could halt the federally-funded SNAP program that provides food stamps. He said he expects the reports from his department commissioners this afternoon.
The musical alter ego of local money manager Jon Shayne is back to his econo-songwriting ways with "The Great Unwind," his take on the policy questions facing the Federal Reserve. As usual, Merle combines insight and education into the song, which sums up the central dilemma this way: "Are we on the mend or near the end of fiat money as we know it?"
SEE ALSO: Merle's other hits