Dying of Whiteness: How the Politics of Racial Resentment Is Killing America's Heartland

by Jonathan M. Metzl

In other words, rarely in the history of recorded time was there a state more in need of, or more ideally fitted for, the ACA and Medicaid expansion than Tennessee. Medicaid expansion would provide coverage for the increasing numbers of people who fell through the cracks due to the failures of TennCare. Expanding the state’s health care infrastructure would also extend its capacity to serve doughnut hole populations. The ACA promised to offset the very costs that TennCare owed, inasmuch as the pooled funds of the federal government would effectively address TennCare’s debt. Evidence also suggested that the framers of the ACA attempted to learn from the lessons of the failure of TennCare specifically by promoting cooperation rather than promoting competition. Indeed, the caveats of TennCare might have positioned Tennessee politicians as sage national leaders as a result of their experiences. As public health scholar Christina Bennett puts it, the nation had the potential to learn from TennCare in order to “prevent similar problems in the national health care plan or in other state’s plans.”