How the owners of a trucking company and digital marketing firm led Tennessee’s push for a Medicaid block grant – The Tennessean

Paul Bailey had heard the term “block grant” for years.

And during that time, like most people, the trucking executive and Republican state senator from Sparta, Tennessee, said he “probably didn’t understand what a block grant was.”

His knowledge level on the federal funding mechanism eventually changed, as Bailey would spend months meeting with experts, coordinating with the governor’s office as it communicated with President Donald Trump’s administration, and becoming one of the faces of a bill that could drastically reform Tennessee’s Medicaid system.

In the House, the bill’s sponsor is likewise not part of the medical or insurance industries.

The expertise of Rep. Timothy Hill, R-Blountville, is in marketing.

For both men, the legislation is the largest, most significant bill they have sponsored in their time in the statehouse, where Hill has served since 2012 and Bailey since 2014.

On Tuesday, the state released its proposal seeking a $7.9 billion block grant to run TennCare, its Medicaid program that provides health insurance for 1.4 million Tennesseans. The proposal seeks greater flexibility from Washington and notably asks the federal government to share 50% of any savings that result from Tennessee coming in under Medicaid spending projections.

Early reactions to the block grant proposal have been mixed, with some health policy experts saying the plan is weighted in Tennessee’s favor and could benefit the state, depending on how negotiations with the federal government unfold. 

Critics are wary. They say the plan is too risky and jeopardizes the health care of poor families, and continue to point to Medicaid expansion under the Affordable Care Act — a political nonstarter for Tennessee Republicans — as the far better solution for the state. 

“Experimenting with the health care of a million people is reckless,” state Sen. Jeff Yarbro, D-Nashville, said Tuesday. 

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For Bailey, ‘sleepless nights’ during block grant bill planning

Bailey, now 51, had always dreamed of one day becoming an elected official.

The third-generation trucker served on the White County High School student council all four years and became student body president.

His classmates wrote in his yearbook that they expected him to become a senator, governor or even president one day, Bailey said.

But in 1986 — when 18-year-olds were still allowed to drive semi trucks — Bailey’s father and grandfather sent him off to drive cross-country the summer after he graduated high school.

CB Trucking, the newly-formed family business that started off with just two trucks and four trailers, quickly began taking off. Bailey left Tennessee Tech University after attending for two and a half years and focused on the growing business and starting a family of his own.

It would be decades before Bailey first ran for office, serving on the White County Commission for three years until being appointed to the statehouse in January 2014 after Rep. Charlie Curtis resigned.

Bailey was already running for state Senate at the time, a position to which he was elected that same November, allowing the then-relatively new elected official to boast that he was a county commissioner, state representative and state senator all in one year.

He largely decided to run for state office to have a hand in limiting government regulation on businesses, including the trucking industry. Bailey helped push legislation to allow farmers to be exempt from commercial driver’s license requirements statewide.

But the Medicaid block grant bill is the highlight of Bailey’s career so far.

“Dollar-wise, it’s the largest piece of legislation that I’ve ever sponsored and carried and passed,” he said.

“It’s probably one of the most significant pieces of legislation that has been passed by the Tennessee General Assembly and signed into law by the governor for many years,” Bailey said.

It’s a bill that Bailey spent the duration of the spring legislative session fine-tuning and seeking input and guidance from experts and working with the governor’s office, TennCare, the Centers for Medicare & Medicaid Services and staff in Tennessee U.S. Sen. Lamar Alexander’s office as they relayed updates from the federal government.

Alexander, who is chairman of the Senate health committee, on Tuesday announced he was supportive of the plan.

“I had sleepless nights during the legislative process,” Bailey said. “You’re basically turning a program that is one-third of the entire state’s budget around. You want to make sure that you’re doing it correctly.”

He stressed over scenarios where, due to some type of oversight, vulnerable patients could lose coverage. Bailey said he wanted to ensure people like his own 88-year-old grandmother, who resides in a nursing home in Algood, or children and the developmentally disabled, would never lose coverage under a shift in the TennCare program.

“All of those things would go through my mind on a regular basis,” Bailey said.

Bailey sees insurance as something that, chiefly, should protect patients from financial devastation due to a major medical event.

“My opinion on insurance is that it is supposed to be that safety net to keep someone from basically having to file bankruptcy if they ever have a catastrophic event in their life,” Bailey said.

And Medicaid, to him, should be viewed as a temporary measure for most adults.

“I think it’s supposed to be there for when you need it in times of tribulation, but I think at some point in time you need to be able to get off TennCare and have traditional-type insurance,” Bailey said of most adults who are enrolled.

With that thinking, he hopes that if Tennessee can find significant savings through a block grant program, that the state will use those funds to allow for coverage for catastrophic medical events for Tennesseans who currently have no insurance.

‘Lightning struck’ when Hill considered Medicaid block grant

Growing up with a father active in Sullivan County Republican politics, Hill, 37, was familiar with the Tennessee political world from a young age.

He recalls visiting the Tennessee General Assembly’s old Legislative Plaza as a child, his father Kenneth Hill pointing out legislators to him and his older brother Matthew, who has now served in the legislature since 2004.

“I ended up at a lot of picnics and a lot of political functions that at an 8-, 9- or 10-year-old shouldn’t be at — a lot of talking, a lot of speeches,” Hill said. “I actually enjoyed it. Having dad take me to that sort of thing probably wasn’t the normal thing of what kids my age were doing on Saturday mornings.”

After unsuccessfully running in a crowded field in 2010, Hill was elected to the House in 2012.

Fast-forward to March 2016, when Hill was attending the Conservative Political Action Conference, or CPAC, in National Harbor, Maryland.

Hill, there to accept an award for the Tennessee General Assembly being named the most conservative legislature in the country, also sat on a panel where block grants were being discussed for transportation projects.

The panel ended.

“Then lightning struck,” Hill said, referring to an idea dawning on him of what could happen by applying the block grant scenario to Medicaid.

Fresh off a refusal by Republicans in his legislature the year before to do a type of Medicaid expansion under the Affordable Care Act — a measure Hill also opposed — he had begun thinking of other possible solutions to improve access to health care in the state.

“‘What can we do?'” Hill recalled having thought. “You can sit back from a legislative standpoint and say we’re not going to do the traditional expansion. But that really is not an answer. Saying no to that point, to me, really wasn’t good enough.”

He spent the next couple of years informally pitching ideas to other conservative politicians around him in Tennessee, recalling that it never seemed to gain traction until soon after Lee was elected governor in November 2018.

Hill secured a meeting with Lee within a month of the election, before the governor-elect was sworn in.

In the first days of session, during an organizational period where the House and Senate were both conducting planning for the year, Hill approached Bailey in his office to talk about sponsoring a block grant bill.

Bailey had been in talks since last summer with Senate Republican leadership about the possibility of pursuing a block grant to attempt to improve state health care offerings.

“It’s definitely something that will be landmark for me personally,” Hill said. “Just because the impact that it’s going to have on individuals.”

While weighing what the state should do about health care after refusing Medicaid expansion with former Gov. Bill Haslam’s Insure Tennessee proposal, Hill said he was inspired by a constituent who works as a cook at Bob’s Dairyland, a barbecue restaurant in Roan Mountain.

He said the woman explained that she did not qualify for TennCare, but struggled to afford health insurance.

“There are people in my district who are hurting,” Hill said. “They’re working and they make too much for TennCare, but at the same time they’re not ready for the ACA or not on the exchange, so what do we do?”

While The Tennessean was unable to identify the cook, she likely would be in the population of working poor who could receive coverage under Medicaid expansion through the Affordable Care Act.

The governor’s office has not said that Tennessee will, in fact, use savings through the block grant program to expand the population of those eligible for TennCare, but rather has emphasized plans to enhance benefits for those current enrolled in the program.

Now that the General Assembly’s work is done until CMS and TennCare reach an agreement on a block grant plan, which would require legislative approval, Bailey and Hill are no longer the architects of the effort.

They’ll wait and see, like the rest of the nation, whether Tennessee can become the first state to strike a Medicaid block grant agreement with the federal government.

Such an outcome would undoubtedly be a major political victory for the two legislators.

But as the governor has said, both sponsors maintain they only want the deal to go through if it is a net positive for Tennessee.

“If it’s not in the best interest of the state program and the patients, we don’t need to do it,” Hill said. “It’s that simple.”

Reach Natalie Allison at nallison@tennessean.com. Follow her on Twitter at @natalie_allison.

Published 11:00 PM EDT Sep 18, 2019

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