A new report highlights what Tennessee could focus on to improve the health of its residents.

The America's Health Rankings 2022 report from United Healthcare ranks Tennessee 44th among states for health outcomes. The state's notable challenges include high numbers of smokers and people with multiple chronic health conditions, as well as premature death rates.

Michele Johnson, executive director of the Tennessee Justice Center, thinks the state is not moving in the right direction because elected officials are not prioritizing and making policies to serve everyone.

"And the top of that list would be Medicaid expansion, refusing to bring back our dollars so that we can have comprehensive coverage for all Tennesseans," Johnson contended. "And that impacts not just those that are covered, but it impacts all of us."

Johnson added she is concerned about what might happen when the pandemic public health emergency expires in the spring. She estimates about 350,000 Tennesseans will lose their health insurance, and believes expanding Medicaid would strengthen the state's health care infrastructure and economy.

The report mentions violent crime as a health factor, and it's on the rise across the country as well as in Tennessee. Tennessee ranks 48th, the same as last year. Nationally, deaths due to firearm injury have significantly increased. Johnson recommended the state find ways to help those who are struggling in order to prevent crime.

"If you want to decrease violence, you have to increase people's basic needs being met," Johnson argued. "There's lots of research that show if you address people's basic needs -- food, health care, and housing -- then the violent crimes go down."

Dr. Rhonda Randall, chief medical officer for UnitedHealthcare employer and individual, said the report shows the full impact of the pandemic, and the most disheartening aspect may be how drug deaths in the U.S. increased by 30%.

In Tennessee, more than 2,300 people died from opioid overdoses in 2020. Nationally, about 70% of the drug deaths are opioid-related.

Randall noted in most cases, it's a nonprescription opioid.

"That means nearly 92,000 additional people died in the United States due to drug injury and overdose compared to the prior year," Randall reported. "The CDC is starting to show that's declined in the last three months now, but we really want to follow it really closely before we call that a trend."

Randall emphasized drug deaths were among all races and ethnicity, but there were some significant health care disparities, with higher rates among multiracial and African Americans.

A coalition of Montana groups will rally at the Capitol Wednesday to advocate for the protection of Medicaid expansion, which legislators will debate this session before the program's scheduled expiration in June.

The state's 10-year-old Medicaid expansion program covers 75,000 low-income Montanans at an annual cost of about $1 billion, according to KFF Health News. The state picks up about 10% of the tab.

Kristen Stewart, Billings organizer for the advocacy group Big Sky 55+ and a caregiver who is enrolled in Medicaid herself, noted many Medicaid enrollees work but the work is often undervalued.

"Medicaid supports a lot of people who are doing unpaid work," Stewart pointed out. "Things that were we to monetize, you would see an economic boost from their production level, often more than the cost of their care."

The Gianforte administration already tightened eligibility for the program, cutting the number of enrollees by nearly 40% between May 2023 and October 2024. The program currently covers nondisabled adults ages 19 to 64 who make less than $21,000 a year.

Jeannie Brown, a bus driver for the Belgrade Public School District and a full-time caregiver and legal guardian for her teenage granddaughter, said if Medicaid expansion does not get reauthorized, she will be on a "slippery slope."

"Because I'm 60 years old and I'm having my own health issues after being a caregiver, it's hard work and it takes a toll on you physically, financially and emotionally," Brown explained. "I'm hoping these legislators really take all of these things into consideration and reauthorize it."

Any laws passed on the issue could also affect the state's behavioral health services, which Gov. Greg Gianforte has made a priority.

Obtaining medical records can be a costly endeavor but there is hope Washington state lawmakers could find a fix this session.

Medical providers look for compensation when producing medical records because of the work involved in the process.

Holly Brauchli, an attorney at Seattle Injury Law, said an outdated process is used to determine the cost. Federal law requires all records to be digitized and Brauchli pointed out providers charge per page as if the records were on paper.

"We download it and we get a bill for thousands of dollars and the justification of that bill is that there's a per page charge," Brauchli explained. "I get these invoices that say copying charge per page. There are no copies."

Brauchli noted there are a variety of reasons why someone would want to obtain their medical records. For instance, the records could be important to an injury lawsuit or someone might want to check if their health insurance was billing them correctly.

Brauchli argued records should no longer be charged as if they are on paper.

"This seems like a really easy fix and certainly one that would help Washington citizens," Brauchli contended. "People have a right to know what's in their medical record and they have a right to be able to see it. So, to me, it's a really simple and elegant fix."

A bill has not been filed yet but is expected from Sen. Tina Orwall, D-Des Moines, soon. The 2025 legislative session starts today.

This Wednesday is the deadline to enroll in Affordable Care Act marketplace health coverage.

Advocates say this year is even more critical for those seeking a plan, because the expanded tax credits that allowed many Kentuckians to enroll in health coverage - at little or no monthly cost - are set to expire at the end of this year.

After Jan. 15, folks will have to qualify for a special enrollment period to take advantage of Advanced Premium Tax Credits while they still exist.

Priscilla Easterling, director of outreach and enrollment with Kentucky Voices for Health, said the state's uninsured rate could potentially increase if families can't afford coverage without the credits.

"I think we should all be very concerned," said Easterling. "Without these enhanced premium tax credits being extended, we're going to see enrollment drop off, because families will no longer be able to afford that monthly premium."

According to research from the Robert Wood Johnson Foundation, the elimination of expanded tax credits would especially impact older adults - who tend to have higher health coverage costs.

In 2024, people over age 50 made up more than one-third of total ACA enrollment.

Easterling said in many cases, for low-income individuals making around $22,000 per year, the credits covered the full cost of their plan, and have saved Kentuckians thousands of dollars a year.

"They have been around for the duration of the ACA," said Easterling, "but the enhanced part that was first expanded in 2021. They have, on average, saved most households over $500 per month."

Easterling said residents can find local experts at kynect.gov to help them take advantage of tax credits and find the best plan for them.

"There are 'kynectors' available in all 120 counties," said Easterling, "who can help and provide free assistance for anyone who needs help navigating Kynect.gov or trying to get enrolled in coverage."

During 2024, more than 71,000 Kentucky residents enrolled in a plan through the marketplace, according to the health advocacy group KFF.

Nationwide, a record 24 million people have signed up for insurance coverage through the Affordable Care Act, according to federal data.