1. Threats to the Children’s Safety Net Programs
Gordon Bonnyman and Keith Barnes
Tennessee Justice Center
March 16, 2017

2. Threats to Health Care
Antonio – heart failure at 42, one month after getting coverage on the ACA.

3. American Health Care Act = “Replacement” Bill in the House of Representatives

4. American Health Care Act: Impacts on Children’s Health Care
The bill eliminates mandatory coverage for certain low-income school-aged children, denying them access to important preventive services including vision, hearing, and dental.

5. American Health Care Act: Impacts on Children’s Health Care
For families with a child or parent with ongoing health needs, the higher cost sharing and premiums that will result from the repeal bill will force families to make difficult decisions about their health care.

6. American Health Care Act: Medicaid
This bill would cut $880 billion in federal funding for to Medicaid and would cap federal funding for the program - which will result in reduced access to coverage and benefits. 

7. Medicaid/TennCare is BIG
Covers 1.55 million Tennesseans
$11.6 Billion total TennCare budget
Provides over half of federal funds in state budget
20¢ of every dollar state spends is federal Medicaid match

8. Medicaid: Per Capita Caps
Per enrollee limits on federal payments to states.
This shifts costs to states, consumers & health care providers.
Makes inequities among states permanent, to the disadvantage of TN and Tennesseans.

9. TennCare is Critical for TN Kids
TennCare = TN’s Medicaid program
Covers half of the babies born in Tennessee, and provides major funding for the state’s network of neonatal intensive care units
Covers over half of all Tennessee children

10. TennCare is Critical for TN Kids
Is the single most important payer for services for children with severe health care needs
Provides health coverage for foster children and former foster children up to age 26

11. Nowhere to Safely Cut
TN is 39th in Medicaid expenditures per enrollee.
TN’s eligibility criteria is already among the strictest of any state.
TN’s provider payment rates and benefits are already among the lowest of any state.
Therefore no way to respond to federal cuts without slashing coverage for the very vulnerable patients who account for most of the cost.

12. Impact on Health Care Infrastructure
Adverse effects on maternal & infant services on which all rely.
Loss of scores of hospitals across rural Tennessee.

13. Impact Beyond Health Care
The American Health Care Act would cut $880 billion in federal funding for Medicaid
In addition to TennCare, 5 departments partially rely on federal Medicaid $$ to fund administration and/or direct services:
Children’s Services
Health
Human Services
Intellectual and Developmental Disabilities
Mental Health and Addiction Services

14. Impact on Education
Cuts to Medicaid will have ripple effect on state budgets
Constraints on budget will force TN to make cuts in other social services, which will affect public schools and secondary education.

15. Threats to Nutrition
Antonio – heart failure at 42, one month after getting coverage on the ACA.

16. Child Hunger in Tennessee
194 million meals missing from our neighbors’ tables
1 in 4 children are food insecure
Poor health and developmental delays
According to Feeding America, even with the existing safety net programs, there nearly 200 million meals missing from our neighbors’ tables in The consequence of that meal gap is that 350,000 Tennessee children are food insecure (1.1 million for all ages); that’s 1 out of every 4 children in our state. To put that in perspective, you would have to double the student bodies of all nine public four-year universities PLUS the seven largest private four-your universities in Tennessee to equal the number of food insecure children (357,920). It’s also important to recognize that only 7 counties have child food insecurity rates below the national average, and most have a rate higher than the state average.
Food is one of the most basic needs. Food insecure children are more likely to experience poor health and developmental delays than their food secure counterparts. According to a report by Bread for the World, nationally, and the authors acknowledge that this is a very conservative estimate, food insecurity among all ages costs $160 billion in avoidable health costs (which is higher than all federal and state spending on higher ed nationwide).

17. SNAP Helps Kids $800 million child nutrition program
SNAP supports health and opportunity
Threats: block granting and deep cuts
While SNAP is a household benefit and does not go to specific members (e.g. kids in the household), it is fair to estimate the benefits that support children at about $800 million/year in Tennessee alone. That’s more than double the federal funding that supports school breakfast and lunch programs in our state.
In Tennessee, 1 in 3 children live in households that receive SNAP including nearly half of all pre-school age children. Low-income children who receive SNAP compared to those who don’t are 16% less likely to be obese and 18% more likely to have completed high school by age 19.
Despite the tremendous importance of this program to ensuring low-income children are better able to reach their full potential and become productive citizens, the threats to the program are now greater than they have ever been. In the coming weeks, we expect to see proposals emerge that would have damaging consequences for some of our state’s most vulnerable youth.
Based on what current leaders have proposed in the last few years, it is likely that attempts will be made block grant SNAP, make deep cuts to funding (10-20%), and otherwise make participation difficult for families and children. Where currently there is at least some guaranteed support for low-income families to put food on the table, block granting could literally mean denying tens, if not hundreds, of thousands of our state’s most vulnerable children one of the most basic necessities. Additionally, it’s important to recognize that a 10% cut in funding to SNAP in Tennessee is roughly equal to our entire Second Harvest Foodbank network. We are expecting this process to begin in the next month with a vote to occur by summer.
It does not have to be this way. We are following threats to SNAP and other child nutrition safety net programs and will keep you up to date on what’s happening and what you can do to fight child hunger for Tennessee’s children and children across the country.

18. Other Child Nutrition Programs Under Threat
School Meals
Provides nearly 700,000 school children with the nutrition they need to learn and be healthy
Repeal of key features of the program and “block grant pilots”
Other Safety Net Programs
$150 million reduction in WIC
21% cut to USDA discretionary funding could also mean cuts to:
The Emergency Food Assistance Program (TEFAP)
WIC Farmer’s Market Nutrition Program (WICFMNP)
Changes to Child Nutrition Act could also impact other programs that support low-income kids in Head Start, day care, state custody, and when school is out
Based on last year’s proposed Children Nutrition Authorization bill, 188,000 Tennessee school children could loose access nutritious school meals due to proposed roll back of a key program provision, Community Eligibility Provision or CEP. Other proposal include conducting a “pilot block grant” in multiple states when many school nutrition directors already make tough budget choices to offer children the most nourishing meals possible.
There are several other child nutrition programs that could see funding cuts or potentially elimination. President Trump’s “skinny” budget includes a $150 million reduction in funding over FY16 levels for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). This is public health program that supports good nutrition for low-income expecting and new mothers and their children through nutrition education and assistance in purchasing healthy foods. With less than half of eligible infants and children participating as it is, cuts could deny even more children a healthy start.
The President’s budget also includes a 21% cut to USDA discretionary spending. That could mean heavy cuts to The Emergency Food Assistance Program, a major source of food distributed through the Second Harvest network as well as Community Action Agencies across the state. This program helps thousands of families put food on the table when other resources are exhausted. It could also impact the WIC Farmer’s Market Nutrition Program. This program is currently available in 8 counties across the state and helps new families get healthy food and supports local farmers.
With the precedents we’re setting other child nutrition programs may also come under threat. These include Summer Food Service Program and CACFP (afterschool meals for at-risk youth, Head Start, day care, and children in state custody).

19. Keith Barnes Nutrition Advocate Tennessee Justice Center 615-846-4716 kbarnes@tnjustice.org

20. Take Action!
Antonio – heart failure at 42, one month after getting coverage on the ACA.

21. House and Senate Action Expected Soon on ACHA
House leaders hope to move the AHCA through committees this week, with a floor vote the week of March 20th
The Senate will try to vote on the bill before they leave for a 2-week recess starting Monday, April 10th
Advocates are hoping Senators Alexander and Corker will oppose the Medicaid proposals being considered by the House

22. They need to hear from us.

23. Call your Representative.
Call Then enter your zip code to be connected to your House member.
Tell them this plan doesn't work for us.

24. TN’s U.S. Senators Play Key Role
Presently 52 GOP Senators, plus the Vice President who can break a tie
Need 3 GOP Senators to vote in defense of health and social programs
Senator Alexander is the most important person in this conversation. He is the head of the Health Committee, and has said that the repeal and replace should happen at the same time.

25. TN’s U.S. Senators Play Key Role
Sen. Lamar Alexander
3322 West End Ave # 120 Nashville, TN 37203
Phone: (615)
Chairs the Senate Health, Education, Labor & Pensions Committee
Senator Alexander is the most important person in this conversation. He is the head of the Health Committee, and has said that the repeal and replace should happen at the same time.

26. TN’s U.S. Senators Play Key Role
Sen. Bob Corker
3322 West End Ave #610, Nashville, TN 37203
Phone: (615)
Senator Alexander is the most important person in this conversation. He is the head of the Health Committee, and has said that the repeal and replace should happen at the same time.

27. Take Action! City Senator Lamar Alexander Senator Bob Corker
Chattanooga
Joel E. Soloman Federal Building
900 Georgia Avenue, #260
Chattanooga, TN 37402
Phone: (423)
10 West MLK Blvd., 6th Floor Chattanooga, TN 37402  Phone: (423)
Jackson
111 Murray Guard Drive, Suite D
Jackson, TN 38305
Phone: (731)
91 Stonebridge Boulevard Suite 103 Jackson, TN 38305  Phone: (731)
Knoxville
Howard H. Baker, Jr.,
U.S. Courthouse
800 Market Street, #112
Knoxville, TN 37902
Phone: (865)
800 Market Street, Suite 121
Phone: (865)
Memphis
Clifford Davis-Odell Horton Federal Building
167 North Main Street, #1068
Memphis, TN 38103
Phone: (901)
100 Peabody Place, Suite 1125 Memphis, TN 38103  Phone: (901)
Nashville
3322 West End Avenue, #120
Nashville, TN 37203
Phone: (615)
3322 West End Ave., Suite 610
Phone: (615)
Tri-Cities
Tri-Cities Regional Airport
2525 Highway 75
Suite 101
Blountville, TN 37617
Phone: (423)
1105 East Jackson Boulevard
Suite 4
Jonesborough, TN 37659
Phone: (423)

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29. Questions?