Scott Morris, MD, thinks people's ability to get healthcare shouldn't have to depend on which side of the Mississippi River they live on.

“Why do people east of the Mississippi have less than those west of the Mississippi?” Morris, CEO of the Church Health Center, asked a group of about 75 people who had gathered at Baptist Memorial Hospital in January to talk about Insure Tennessee.

The answer depends on state lawmakers. On the west bank, the Arkansas legislature approved a plan to use funds provided under the Affordable Care Act to purchase health insurance for low-income residents on the government healthcare exchange. More than 200,000 of those eligible signed up after the program began in 2014. 

To the east, Tennessee lawmakers last year voted against a plan to cover state residents in similar financial circumstances. 'No' votes by a bloc of Republicans on two Senate committees kept the Insure Tennessee proposal from getting to the Senate floor.

Whether the states decide to use it or not, federal money to expand Medicaid is available under the ACA.

Insure Tennessee is Republican Gov. Bill Haslam's proposed alternative to Medicaid expansion that would cover an estimated 280,000 uninsured residents who don't qualify for TennCare, the state's Medicaid program, and have incomes under 138 percent of the federal poverty level.  About half of those uninsured residents work.

Morris is immersed in the “coverage gap.”

“Over 90 percent of the patients at Church Health Center are working and uninsured,” Morris said. “They're in that position where they don't qualify for anything.” And there are 900 people on the waiting list to become CHC patients.

The forum at Baptist Hospital regarding Insure Tennessee had nearly 30 supporting hosts, including Shelby County Mayor Mark Luttrell, newly elected Memphis Mayor Jim Strickland, former county Mayor Jim Rout and CEOs of Baptist Memorial Health Care, Methodist Le Bonheur Healthcare and Regional One Health. 

The audience heard from Cyril Chang, PhD, economics professor and director of the Methodist and Le Bonheur Center for Healthcare Economics, who said many of the 280,000 “Swiss cheese people” who fall through the holes of insurance coverage in Tennessee work in food service, construction, maintenance and transportation.

A page in his PowerPoint presentation said “Medicaid expansion would have brought an estimated $352 million of federal dollars to Shelby County between 2014 and 2016 at no extra cost to the state.” (The italics are Chang's.)

According to academic estimates, Insure Tennessee would have brought more than $1 billion to the state each year and created 15,000 jobs. 

Greater Memphis Chamber CEO Phil Trenary said a unanimous 120 members of the Chamber's Chairman's Circle support it.

But the speakers were preaching to the converted. The forum was designed to win over Republican state legislators who must approve Insure Tennessee. They weren't there.

Rout, the Republican former mayor who's now president and CEO of BankTennessee, invited seven members of Shelby County's Republican delegation to attend the forum. None did.

A Memphis Medical News reporter called the lawmakers to ask why they didn't attend. 

State Rep. Mark White said he supports Insure Tennessee but couldn't get to the forum because he was having a tooth extracted at the time. Rep. Curry Todd didn't return email or phone messages; an aide who answered the phone in his Nashville office said, “Not one of his constituents in Germantown and Collierville has called asking why he didn't attend.” 

Rep. Steve McManus didn't reply to an email or phone calls. Rep. Jim Coley's office aide said he didn't go because of “health issues.” Rep. Ron Lollar wrote in an email that he had a previous appointment: “Sorry I couldn't make it. Thanks for asking. Ron”. 

Sen. Mark Norris said via email that he had been contacted by two hosts but regretted because of a “prior commitment out of state.”

Sen. Brian Kelsey, an outspoken opponent of Insure Tennessee, had intended to go but had to work in his law office until midnight Jan. 7, according to an aide in his office.

As the legislature convened for its 2016 session, Lt. Gov. Ron Ramsey, speaker of the Senate, told the Times-News in Kingsport that Insure Tennessee wouldn't be reconsidered during this legislative session since a new U.S. President is going to be elected in November and a new administration might change the healthcare program: “The timing is bad now,” Ramsey said. 

Morris told the audience at Baptist about a patient he had seen at Church Health Center that day – a construction worker who needs a knee replacement and had been using duct tape to stabilize his knee.

“We have the ability to get his knee replaced,” Morris said. “We have a thousand doctors who volunteer with us, and as long as doctors volunteer, the hospitals provide facilities.  Smith & Nephew will give us a knee. It's a wonder to behold how this all works. “But he (the patient) asked if he'd have to miss work if he had the surgery. He doesn't get paid if he doesn't work. What doesn't exist is the means for him to pay his light bill in the winter if he doesn't work.”

Morris, who's also a minister, says Insure Tennessee makes sense financially “without question,” but he thinks it shouldn't be an economic or political issue. “If we view this as a question of what is the morally right thing to do, it certainly changes the tenor of the conversation when that happens," he said. 

Based on attendance at the recent forum, it would have to be a one-sided conversation.

Peggy Burch has served as a former government and politics editor at The Commercial Appeal during a 35-year career as a reporter and editor at two major newspapers.