Democrat Karl Dean is banking on Medicaid expansion as his winning issue in Tennessee's race for governor, while Republican Bill Lee claims the plan would be detrimental. The opposing views represent the sharpest divide between the candidates.
Democrats say as many as 300,000 people would be covered if Tennessee expanded Medicaid. But businessman Bill Lee of Franklin sees pitfalls.
"Expanding a broken, flawed system by taking federal money and moving something down the road that is fundamentally flawed, I believe, is a mistake for Tennessee," Lee said at the first debate against Dean.
Lee says he has "a different plan," though he hasn't proposed anything concrete. He talks broadly about incentivizing patients to care for their health in the least costly way.
The Dean campaign, by contrast, is running negative ads, highlighting Lee's opposition. Dean even flew in the Democratic former governor of Virginia for a roundtable discussion to show that a Republican legislature can be convinced.
Some supporters warn that the focus could backfire, scaring off moderate GOP voters. Dean puts stock in a Mason-Dixon poll from earlier this year that found nearly two-thirds of Tennesseans support expansion.
"I don't think it scares people," Dean told WPLN. "I think people just need to understand the ramifications of the decision that was made not to do what Governor [Bill] Haslam wanted us to do — expand Medicaid — and that has hurt us. And now we need to do something to change that."
The former Nashville mayor often reminds audiences that his opponent's position conflicts with the current Republican governor.
And Dean predicts more damage is looming. Ten communities have lost their only hospital in recent years, when Medicaid expansion could have propped them up.
"It was a definite wakeup call in 2014," says Bill Rawls, the mayor of Brownsville in West Tennessee, where the hospital, owned by Franklin-based Community Health Systems, closed after already struggling because of economic decline in the region.
He says the closure was an eye-opener, even for conservatives who are now learning how hard it is to recruit jobs without a hospital.
But the hatred of Obamacare dies hard. Rawls imagines someone in dire straits, uninsured at the hospital door, still turning down coverage.
"People want 'the Affordable Care Act,'" he says. "But they don't want 'Obamacare.'"
Rawls admits, it's unlikely that his or any other closed hospital would revive, even if Medicaid were expanded. But, he says, it could at least support whatever replaces shuttered rural hospitals.