TALLAHASSEE, Fla. -- It's been two years since the onset of Medicaid expansion, and a new report says it's paying off for states that have helped close their "coverage gaps" with economic benefits for health-care systems and the people they serve. But Florida is missing out.

More than a half-million Floridians can't afford marketplace health insurance but don't qualify for Medicaid. The research pointed to a ripple effect on the stability of the state's health-care delivery system.

Florida House Minority Leader Mark Pafford, D-West Palm Beach, chief executive of Florida Community Health Action Information Network (CHAIN), blamed the Legislature's failure to act for Florida hospitals having to cut staff and reduce services.

"I'm talking about the providers dealing with people who need health insurance, who are in poverty many times, who are working full-time jobs," he said, "and so that economic impact to those hospitals is really unjust."

According to the report from the Georgetown University Center for Children and Families, hospitals and clinics in Medicaid expansion states report opening new facilities, buying new equipment and hiring staff. To date, 31 states and the District of Columbia have chosen to expand Medicaid. Report co-author Jack Hoadley, a research professor at the Georgetown center, said states that have expanded Medicaid have seen major reductions in the amount of uncompensated care delivered by safety-net institutions, signifcant drops in the number of uninsured residents and budget savings for hospitals and community health centers.

"This is the kind of ripple effect," Hoadley said. "It's not just the patient now comes in and gets a service, or now comes in and is able to pay for the service as opposed to receiving charity care, but the dollars that are saved -- or the dollars that are brought in to these institutions -- really are used in ways that really fundamentally change the way care is delivered."

Pafford said he finds it ironic that Gov. Rick Scott has taken such a strong stand against Medicaid expansion but is asking the federal government for more money to help prevent and monitor the spread of the Zika virus in Florida.

"So, at a time where the state's ability to respond should be at its greatest," Pafford said, "he turned his back on Medicaid expansion, which was the delivery of those dollars to react to Zika."

Opponents of expanding Medicaid often claim it will place a higher financial burden on state budgets, but the report found fiscal benefits for many expansion states -- from $25 million in savings in Kentucky to $100 million in Washington state.

The report is online at ccf.georgetown.edu.


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A coalition of South Dakota groups is voicing its opposition to a ballot measure intended to end a state sales tax on consumables.

If passed this November, Initiated Measure 28 would repeal the state's 4.2% sales tax on "anything sold for human consumption," including food and other products from toothpaste to tobacco, CBD and vaping products.

Sandra Waltman, director of public affairs for the South Dakota Education Association, said the teachers union opposes the repeal because it does not include a plan to replace the money the current tax contributes to education.

"Our main reason for opposing this is the lack of a plan for replacing the $176 million and what that will do, not only for K-12 students but for higher education," Waltman explained. "Districts would probably be looking at a very bare-bones budget."

Currently, Waltman said about 60% of public school funding comes from state coffers, and the other 40% from local property taxes. She called the potential effect on education "drastic," saying they could lead to fewer teachers, larger class sizes and cuts to newer resources like mental health support and programs for career and technical education.

Proponents of the measure said repealing the tax could help the nearly 9% of South Dakotans who are food insecure but Waltman countered the same people would likely feel the effects of underfunded school systems.

"To repeal one tax without a more broad conversation about how you replace that revenue is shortsighted, and we think you shouldn't just be repealing a tax without a plan."

Other groups opposing the measure include the South Dakota Cattlemen's Association, Chamber of Commerce and Industry, South Dakotans Against a State Income Tax and the South Dakota Farm Bureau.

North Dakota officials will highlight a new project today to boost childcare access for parents with nontraditional work hours.

A local provider likes what the state's been doing to help facilities and families but hopes for more action. Health and Human Services leaders will appear at a child care facility in Fargo to discuss a pilot initiative, giving operators financial incentives to increase capacity for childcare slots outside the hours of 7:30 a.m to 5:30 p.m.

Kathy Busche, owner of Kathy's Kids Daycare in Hazen, said she will need to see more details but would have interest in signing up. She explained it has been a big need in her area.

"We're right in the middle of coal country and so, a lot of our plant workers are working 12-hour shifts, starting at 6:30 in the morning," Busche observed. "We have hospital workers that are working 12-hour shifts."

The announcement is part of a series of investments the state adopted last year to ease the childcare burden felt across North Dakota. Busche noted she especially likes the inclusion grant to provide day care for kids with special needs. She feels the state could go further in offering incentives to retain staff.

The state has been providing a stipend, which maxes out at $3,600, to help stabilize the child care workforce. Busche emphasized her workers have already used up their portions.

"Now, there's really no incentives left to keep staff," Busche contended. "Without staff, we can't have more kids."

Busche feels the state should not write a "blank check" to address problems and wants policymakers to keep evaluating what is working. She hopes staff retention is among the topics state lawmakers revisit when they return to session early next year.

By Ashli Blow for Tennessee Lookout.
Broadcast version by Danielle Smith for Tennessee News Service reporting for the Solutions Journalism Network-Public News Service Collaboration

Rebecca Maino would set aside $20 each month for her house repairs. Her aging home in Memphis had a leaky sink, an outdated air conditioner, and holes in the walls.

It just wasn’t enough to cover the costs. On her limited budget, she couldn’t manage to save more money while paying her family’s bills.

“When [contractors] come in and the scope of work that they tell you is thousands of dollars, people that are on fixed incomes that have worked their whole life to pay their home off, they simply cannot afford that,” said Maino. 

Over the years, the inconvenience evolved into a safety concern. With the increasing frequency of extreme weather — like last week’s deadly, subfreezing temperatures — her energy-inefficient home was becoming a health risk. Maino turned to Memphis Gas Light and Water (MLGW) and their weatherization program that could help with improvements. 

As storms intensify, environmental coalitions are backing these assistance programs as a viable climate solution in southern cities like Memphis. Weatherization gives residents the resources they need to protect themselves while reducing energy use from sources that emit climate-altering pollution. It also reduces energy during peak power demands that Tennessee now experiences as people try to stay warm in winter weather.

Weatherization programs have a longstanding presence across the nation. It’s a strong policy framework that MLGW has adapted into a program that is uniquely its own, some of which comes down to Memphis grit: the people behind the program who are dedicated to working hard for their community. 

“I take my job personally, because I came from a challenging upbringing right here in Memphis. I know what it’s like to be cold in the wintertime, hot in the summertime, and not having a lot of necessary needs to be met,” said David Wright, the technician who was assigned to Maino’s case. 

“We can’t rebuild a house all over again,” he said. “We try to make the [recommendations] the best that we possibly can give to a customer and to meet the needs they have.” 

When Wright showed up at Maino’s doorstep, that’s exactly what he did. He walked Maino through the issues while writing a work order that prescribed her a new air conditioner and heater, pipe repairs, and wall patchups. That order also identified the contractors responsible for installing appliances and making the necessary fixes. 

Maino never received an invoice, because the ratepayers had it covered. 

$8.3M in ratepayer donations funds weatherization projects 

In 2016, a MLGW customer-led advisory board told the utility it wasn’t doing enough with Share The Pennies—a small program that rounded up utility bills to the next whole dollar for weatherization services. For three years, customers were given the option to donate their extra change, but many weren’t checking the box. 

The board worked with Memphis City Councilmember Patrice Robinson to propose a resolution that would make Share The Pennies an opt-out program, asking customers to remove themselves if they didn’t want to participate. The city council passed it. 

Margie Borrum-Smith took the calls from unhappy customers. 

“People would say, ‘I don’t want anybody telling me what to do with my money,’ but when they hear about what’s going on, they want to participate,” said Borrum-Smith, who is now the manager of MLGW’s energy services and oversees the Share The Pennies program. 

Customers contributing to the program give about $12 each year, resulting in a collective revenue of $8.3 million. It has funded the weatherization of 935 homes. 

But, managing the program budget is not just about the quantity of work, it’s about the quality of the work, said Borrum-Smith. 

MLGW technicians oversee home projects from beginning to end. To perform services, they are required to hold certification as a home energy rater, an accreditation recognized by the U.S. Department of Energy. 

Trained to conduct ethical inspections and uphold industry standards, they offer cost-saving recommendations and investments in sustainable appliances such as heat pumps—an energy-efficient technology capable of both heating and cooling homes.

During installations, technicians collaborate with a roster of 41 local contractors, with many being small businesses owned by people of color and women. Together, they adhere to a set of standards and code enforcements.

“In the end, the technician has to sign off and the customer has to sign off,” said Borrum-Smith. “It’s the technician that should be asking, ‘are you satisfied?’ Because we shouldn’t let anything pass that should not be like we want it in our home.” 

The demand for weatherization services exceeds what Borrum-Smith’s team can currently meet. In addition to better living conditions, people want more affordable monthly utility bills. 

Memphis has one of the highest energy burdens nationally, where families or individuals allocate a significant portion of their income to utility bills. Thirteen percent of households face energy burdens, nearly 10% higher than the national average, as reported by the American Council for an Energy-Efficient Economy. 

MLGW’s next enrollment period opens on Tuesday. The utility partners with the Metropolitan Interfaith Association to manage the hundreds of people who ask for weatherization services. In past years, they’ve received so many applications, they closed the portal in just a day. 

Borrum-Smith hopes that the program can eventually offer a second enrollment period each year, but this expansion would require more funding. Despite that MLGW receives federal and state funding for weatherization programs, as well as contributions from ratepayers, meeting the pace and scale of demands will require more funding. 

Energy efficiency as a solution in motion 

Weatherization is among America’s oldest resiliency policies. 

In response to the 1973 oil crisis that brought about soaring energy costs, the U.S. The Department of Energy created its weatherization assistance program. Now, nearly half a century later, the Biden administration is using similar approaches as a tool to meet climate targets with unprecedented funding packages for clean energy. 

“Weatherization is key from a climate resilience standpoint,” said Will Bryan, policy director with the Southern Energy Efficiency Alliance. 

“There are two dimensions to this,” he said. “There’s certainly reducing greenhouse gas emissions, which is vital and which weatherization does. The other benefit improves the kind of resilience of a household in the face of climate impacts.”

The impacts of climate change, such as hotter summers and more intense winter storms, pose dual threats to both safety and the operational integrity of energy grids. Tennessee Valley Authority, the energy provider for MLGW, has been grappling with these challenges. 

In recent years, the utilities have implemented rolling blackouts due to high electrical demand that strains its energy grid. Just last week, they jointly issued energy conservation alerts, urging customers to voluntarily reduce their energy usage when temperatures dropped to single digits.

While cohesive emergency plans and the adoption of clean energy sources are imperative for a holistic climate response across Tennessee, these solutions are years away. But weatherization already has a strong policy groundwork. 

That’s why Bryan and his colleagues at SEEA are actively aiding state energy offices now on home energy programs, offering guidance on effective strategies for administering and allocating federal funding. He anticipates that millions of dollars could come through Tennessee because of initiatives such as the Inflation Reduction Act and the Bipartisan Infrastructure Law. These funding packages offer rebates and other funding streams that can be used to directly lower the cost of energy improvements. 

Already, Memphis city planners funneled $500,000 awarded from the American Rescue Plan Act into the Share The Pennies program last year. 

As program managers and energy consultants try to expand their financial resources for weatherization programs, they are grateful to customers like those at MLGW who are helping their neighbors. This accessible and dependable revenue source is something even Share the Pennies participants, like Maino herself, can contribute to. With her monthly utility costs now $30 lower, Maino rounds up her bill, passing on the assistance to others. 

“Everybody wants to be Bill Gates. Everybody wants to be Warren Buffet, but the reality is when you’re a single mother, like I am, I don’t have the liberty to sit here and write a $10,000 or $10 million check,” said Maino. “But rounding up to the nearest dollar, that’s not going to affect anyone’s bottom line.”


Ashli Blow wrote this article for Tennessee Lookout.


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