Why a Red-State Democrat Wants to Campaign on Health Care

Former Tennessee Gov. Phil Bredesen says he's eager to spend six years in the Senate working on an issue that, not long ago, many Democrats—particularly in the South—were afraid to discuss.

Tennessee Senate candidate Phil Bredesen
Courtesy Phil Bredesen for Senate
June 25, 2018, 8 p.m.

KNOXVILLE, Tenn.—At a campaign event at the East Tennessee Children’s Hospital last week, Phil Bredesen’s gold cufflinks of brown bears peeked out from the buttonholes in his light blue Oxford shirt. He explained that years ago, he traveled to Alaska to hunt, but found the bears so charming that he put down his gun in favor of fishing alongside them. The brown bear, he said, is his “iconic animal.”

The metaphor seemed clear: This is a man who would rather work with you than take you out. That was his style when he was governor of Tennessee and mayor of Nashville. But now, in a new political era dominated by President Trump, that centrist way of governance is under total assault. Bredesen’s race for Senate, against the hard-line conservative Rep. Marsha Blackburn, will test whether it can ever come back.

With Senate control in the balance, the challenge for Bredesen will be to prove to Tennesseans why they should vote for a man Trump has called a “tool” of Senate Democratic Leader Chuck Schumer. Bredesen’s retort is that he has the experience to change a dysfunctional Washington and the willingness to reach across the aisle to actually do it—particularly on health care.

“There’s nothing that would please me more [than] spending six years of my life, if I’m elected this fall, in trying to actually make some honest-to-God, real progress in how health care is delivered in this country,” Bredesen said.

Before a roundtable of a dozen middle-aged, middle-class women, including health care professionals, attorneys, a stay-at-home mom with a baby bouncing on her lap, and a contractor who beat breast cancer, Bredesen heard story after story about people trying to get by. He heard about one woman trying to avoid the Affordable Care Act’s “subsidy cliff,” another’s lament about inadequate access to birth control, and everyone’s struggle to pay deductibles and insurance premiums.

Across suburbia, Democrats in competitive House races have knocked Republicans for supporting a bill that would have increased the number of uninsured Americans by 23 million over a decade. Blackburn voted for that bill to “repeal and replace” Obamacare. Bredesen said he wouldn’t have, because “they forgot the replace.”

But Bredesen didn’t expressly use that vote as a cudgel against Blackburn. “I don’t think anybody cares about that,” he said.

Instead, he zeroed in on the opioid epidemic, and Blackburn’s sponsorship of a bill in 2016 that 60 Minutes and The Washington Post reported weakened the Drug Enforcement Administration’s power and exacerbated the crisis.

“What happened two years ago was the swamp in action,” Bredesen said in an interview. “Congressman Blackburn has this huge amount of contributions from Pharma, and it’s not because of her sophisticated views about pharmacy or something like that.”

Abbi Sigler, Blackburn’s campaign spokeswoman, notes that the bill passed the House and Senate with unanimous consent and was signed into law by President Obama. She said that Blackburn has recently introduced a bipartisan bill that would boost funding to combat the crisis and increase civil and criminal penalties for opioid manufacturers who fail to report suspicious orders.

“While Bredesen talks, Marsha continues working hard and taking action to stop the opioid epidemic, as she has for years,” Sigler said.

It makes sense for Bredesen to focus on health care. The public views Democrats as better equipped than Republicans to deal with health care issues, according to Kaiser Family Foundation polling.

John Geer, a professor of political science at Vanderbilt University, doubted Blackburn could “make much hay out of the ACA,” and said she would have to “tread carefully” on the opioid issue. “Bredesen has a strong record on being fiscally responsible on health care,” Geer said. But Tom Ingram, a longtime Tennessee Republican political consultant, said no one has “really raised” the opioid issue yet, and noted that there’s still a “general aversion” to Obamacare in the state, as evidenced by the legislature’s refusal so far to expand Medicaid.

Bredesen has worked on health care issues most of his life. Before entering politics, he was the CEO of HealthAmerica Corp, a large health care management firm. When he was governor, he kicked nearly 200,000 people off the rolls of TennCare, the state’s Medicaid system for the elderly and the poor, to stabilize the program after massive cost overruns.

Before leaving office in early 2011, he published a book, Fresh Medicine, that criticized the Affordable Care Act for not addressing “the deep structural problems of health care,” including “cost, sustainability, inconsistent quality, fragmentation [and] the focus on heroic interventions.” He described the law's individual mandate as something that gives “a lot of reasonable people indigestion.” Republicans in Congress got rid of it in their tax-overhaul bill last year.

Bredesen’s aim is still universal coverage, and he supports Obamacare’s Medicaid expansion, even though he still considers it the “mother of all unfunded mandates.”

He said he doesn’t think Obamacare is the long-term solution, but it’s unclear whether he’d embrace single-payer models like Sen. Bernie Sanders’s “Medicare for all.”

“Saying you are for single-payer or not is like saying are you for war or not,” Bredesen said. “Well, tell me a little more.”

Blackburn’s health care positions line up with GOP orthodoxy. She has campaigned on repealing Obamacare, expanding health savings accounts, promoting association health plans, and allowing consumers to purchase health insurance across state lines to lower costs.

“Phil Bredesen praised Obamacare and wants to put government in control of our health care decisions,” Sigler said. “That’s not what Tennesseans want. They know the false promises of a government-controlled system.”

But Republicans poll better on economic issues than on health care. Sen. Lamar Alexander of Tennessee noted that if he were the Republican nominee this year, “I’d be emphasizing the economy—the best economy in 18 years, the biggest tax reform in 31 years, the most regulations reduced that anybody can remember, and a conservative Supreme Court justice.

“I’d stick to that,” he added.

The polls show that Bredesen is leading the race. But it has yet to really begin in earnest, and Blackburn’s bombastic style may prove to be more in tune with a state that gave Trump more than 60 percent of the vote. The state's retiring GOP senator, Bob Corker, said that it’s a “really unique year” in which “issues don't seem to be as important” as before.

Bredesen has refrained from criticizing the president much. In the health care roundtables last week, he didn’t mention Blackburn or Trump by name. In the interview, he said this was his fourth such health care-focused discussion, and the first time he had criticized the administration’s actions in any of them. Even then, in knocking the separation of children from their families as “horrible” and effectively “child abuse,” he focused his ire not on Trump but on the ills of partisanship and people not working together. “Everybody is spending their time covering their own rear ends by passing blame,” he tweeted.

In her response, Blackburn blamed Democrats for the Trump administration’s policy of separating children from their families at the border, keeping in step with her stance as a strong Trump ally. On her campaign website, she asks her followers to pledge themselves to Trump’s agenda, telling them that she’d support his push for an immigration ban of Muslim-majority countries and a wall on the southern border.

“She has just double-downed, triple-downed, quadrupled-down on 'anything Trump wants, I’m for,’" Bredesen said. “That’s a legitimate point of view, but I don’t think that’s what a senator should be.”

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