Public Policy Research and Analysis

Below you’ll find The Sycamore Institute’s research, analysis, issue briefs, legislative summaries, commentary, news, and other resources to help you navigate the complex public policy issues that affect and connect Tennesseans’ health and well-being, prosperity, and the state budget.

ALL PUBLICATIONS

What and How Much Will Tennessee Get from the American Rescue Plan

The new federal law could bring $20-30 billion into Tennessee, including $6.3 billion in flexible funds for state and local governments.

TennCare III: Frequently Asked Questions

Is Tennessee’s new Medicaid waiver a block grant? Get clear, concise answers to 13 frequently asked questions just like that one.

2019 Income, Poverty, Education, and Insurance Coverage in Tennessee’s 95 Counties

Census data for Tennessee’s 95 counties continue to show large differences in household income, poverty, education level, and health insurance coverage.

TennCare III: Unpacking Tennessee’s New Medicaid “Block Grant”

An unprecedented and complex set of new incentives and opportunities for state policymakers, as well as new uncertainty for the people enrolled.

Fees, Fines, and Criminal Justice in Tennessee

Even if not convicted, people charged with crimes in Tennessee often face substantial fees, fines, taxes, and other financial obligations.

Economic Opportunity and Upward Mobility in Tennessee

The biggest differences occur between neighborhoods that are often just miles apart.

2019 Census Data on Income & Poverty in Tennessee

Tennessee saw large improvements in household income and the poverty in 2019, but both metrics still trail the national average.

2019 Census Data on Tennesseans’ Education Levels

Differences in post-secondary education rates among white, black, and Hispanic Tennesseans are shrinking, but significant gaps remain.

2019 Census Data on Health Insurance Coverage in Tennessee

The Tennesseans least likely to have health insurance in 2019 were men, Hispanics, younger adults, the unemployed, and people with less education & income.

Tennessee’s Public Health Infrastructure

From the flu to salmonella to COVID-19, major disease outbreaks often focus the public eye on public health. But what does that phrase mean, exactly?

Covid-19 and Medical Debt in Tennessee

Before COVID-19, one in five Tennesseans already had medical debt on a credit report. This pandemic and recession could make it an even bigger problem.

5 Simple But Important Things to Know About Statistics

Statistics and data points can provide valuable information about the world around us, but they’re also easily misunderstood and misused.

Coronavirus Recession: Tennessee’s Most Vulnerable People, Places, and Employers

The most at-risk businesses employ 1 in 4 private sector workers, who earn 40% less than average and are more likely to be minority, young, and have less education.

Federal Coronavirus Funding for Tennessee

Tennessee will get over $25 billion in federal aid, including $8 billion to state government. Much of the relief has already occurred or will soon expire.

Unemployment Insurance in Tennessee

Over the last two decades, Tennesseans have been less likely than other out-of-work Americans to get unemployment benefits. Meanwhile, the value of those benefits has fallen

Which Tennessee Counties Might See the Largest Drop in Sales Tax Revenue?

As the coronavirus’ economic toll grows, the Great Recession offers clues for how falling sales tax revenues will affect county budgets.

How State Policy Shapes Local Governance in Tennessee

Tennessee’s local governments often have the most impact on our daily lives, but state policies frequently shape their options, decisions, and priorities.

5 Ways to Measure Prosperity in Tennessee

Unemployment, labor force participation, GDP, income, and poverty are five of the many ways to measure growth and prosperity in Tennessee.

Measuring Prosperity: Gross Domestic Product

While GDP offers valuable insight into Tennessee’s economy, there are many aspects of economic well-being it does not capture.

Measuring Prosperity: Labor Force Participation

Tennessee’s labor force participation rate is consistently lower than the national average, but the gap has narrowed in recent years.

Measuring Prosperity: The Unemployment Rate

The unemployment rate measures the share of Tennessee’s labor force without a job, but not all working-age adults count as “in the labor force.”

Measuring Prosperity: Poverty

We measure poverty to gain insights into how many people have trouble meeting their basic needs.

Measuring Prosperity: Personal and Household Income

Measures of household and personal income gauge the financial support Tennessee residents have from wages and some – but not all – other sources.

Crowded Jails and Prisons Raise COVID-19 Risks for Every Tennessean

Recent data show 46 Tennessee jails had more inmates than beds. Such close quarters make it hard to slow the spread of COVID-19 and could lead to new outbreaks among the public.

What Will the Coronavirus Recession Mean for Tennessee’s Budget?

The pandemic has serious health and economic effects, yet Tennessee still has to balance its budget. These are the challenges policymakers face and the tools they have right now.

A Deep Dive into Health Insurance Coverage in Tennessee

For better or worse, robust access to the U.S. health care system is largely predicated on having health insurance.

4 Reasons an Accurate Census Matters for Tennessee

Tennessee will use the 2020 census to allocate taxpayer resources, redraw legislative districts, and make countless policy decisions over the next decade.

The Budget in Brief: Summary of Gov. Lee’s FY 2021 Recommended Budget

Gov. Lee unveiled a range of priorities with his second budget, most notably in the areas of teacher pay, literacy, mental health, and criminal justice.

How TennCare’s Block Grant Proposal Compares to New Federal Guidance

Even if Tennessee’s plan has a separate path to approval, it’s likely to undergo significant changes.

2018 Income, Poverty, Education, and Insurance Coverage in Tennessee’s 95 Counties

Census data for Tennessee’s 95 counties continue to show large differences in household income, poverty, education level, and health insurance coverage.

What’s in Tennessee’s Medicaid Block Grant Request?

TennCare’s latest proposal retains the same basic components as the September 2019 draft with some new specifics and assurances

The Roots of a Thriving Tennessee

Families, businesses, and our economy all thrive when people enjoy good health, social and financial well-being, and the chance to make meaningful contributions to society.

TennCare Enrollment by County in 2019

TennCare enrollment is highest in Tennessee’s most populated county, but more rural counties have the greatest share of the local population enrolled.

Medical Debt in Tennessee: 12 Options for State Policymakers

Explore 12 ways Tennessee’s governor and state lawmakers could prevent medical debt, help people manage it, and mitigate its effects.

Income, Poverty, Education, and Insurance Coverage in Tennessee in 2018

Analysis of U.S. Census Bureau data on Tennessee’s economy, with a regional look at 14 population centers across the state.

Breaking Down TennCare’s Block Grant Proposal

The plan would give state officials unprecedented control over major aspects of the program and weights a new funding formula in TennCare’s favor.

Medical Debt Across Tennessee’s 95 Counties

Counties with high rates of medical debt tend to have more uninsured residents, auto/retail loans and delinquencies, and payday lenders per capita.

What You Might Have Missed in the 2019 Legislative Session

Changes to TennCare, education, criminal justice, online sales tax, sports betting, and fiscal notes had significant budget implications.

Medical Debt 101: How a Medical Bill Becomes Medical Debt

Medical debt is unique from other types of debt for its connection to health-related circumstances that individuals often cannot predict or control.

Medical Debt in Tennessee: Who Has It and Why Does It Matter?

Medical debt is surprisingly common in Tennessee across most demographic and socioeconomic groups, and it can have far-reaching effects on prosperity and health.

Tennessee Health Care Capacity Dashboard

Data on the hospital, primary care, and substance abuse/mental health care resources available in each of Tennessee’s 95 counties.

Medicaid Block Grants: The Unknown Details Matter

Critical details are missing from a proposed Medicaid block grant for Tennessee. Its effect on TennCare’s budget and flexibility from federal rules are unclear.

The Budget in Brief: Summary of Gov. Lee’s FY 2020 Recommended Budget

The governor’s recommended Budget for FY 2020 totals $38.6 billion, an increase of 1.1% over estimates for the current fiscal year.

Community Supervision, Prison Releases, and Recidivism in Tennessee

The cycle of supervision, release, and recidivism is a significant driver of Tennessee’s state prisoner population.

Pre-Trial Detention in Tennessee

Half of Tennessee’s local jail inmates in 2018 were people awaiting trial, conviction, or acquittal for felony or misdemeanor charges – up from 30% in 1990.

Incarceration in Tennessee: Who, Where, Why, and How Long?

Current and historical incarceration trends for Tennessee’s state prisoner population provide context for discussions about criminal justice reform.

Budgeting for Incarceration in Tennessee

Facts and trends on how Tennessee budgets for incarceration of state prisoners, which is consistently among the largest state revenue expenses.

The Economic Cost of ACEs in Tennessee

The economic cost of adverse childhood experiences (ACEs) among Tennessee adults was $5.2 billion in direct medical costs and lost productivity in 2017.

Tennessee’s Budget May Not Be Ready for the Next Recession

Tennessee’s budget may not have enough rainy day reserves to withstand the next recession without tax hikes or spending cuts.

2017 Income, Poverty, Education & Insurance Coverage in Tennessee’s 95 Counties

Census data show large differences in household income, poverty, education, and health insurance status between Tennessee’s rural and urban counties.

Where You Live Affects How Long You Live

Our neighborhoods can affect our access to factors that influence health. Use the map to explore how life expectancy varies across Tennessee communities.

5 Issues for Tennessee’s Next Governor and General Assembly

No matter who wins the election, these 5 challenges could keep Tennessee’s next governor and General Assembly busy throughout 2019 and beyond.

Tennessee’s Uninsured in 2017

Our 3 takeaways from 2017 data on the uninsured in Tennessee and for the Chattanooga, Memphis, Knoxville, Kingsport-Bristol, and Nashville-Murfreesboro metro areas.

Video: Tennessee’s Poor Health Hurts Our Economy

Tennessee is a great place to live. But we’re less healthy than the rest of the country, and that hurts our economy. Watch to learn how.

Obstacles to Work among TennCare Enrollees Potentially Affected by a Work Requirement

Education levels, poor health, and lack of home internet access or personal vehicles could hinder the ability of many to get and keep a job.

The Opioid Epidemic in Tennessee: 2018 Update on New Policy Actions

We review the numerous steps Gov. Haslam and TN lawmakers took during the 2018 legislative session.

The Opioid Epidemic in Tennessee: 2018 Update on Indicators of Progress

The most up-to-date data in 2018 show recent trends persist — the supply and potency of prescription opioids are falling, but negative outcomes continue to climb.

Check Out Our 95 County Health Profiles

Our County Health Profiles examine health outcomes and the drivers of population health in all 95 TN counties.

The Drivers of Health

Research shows 4 broad factors other than genetics influence our health.

3 Takeaways from Proposed 2019 ACA Plans in Tennessee

Expect premiums for many popular plans to fall in all 95 counties next year and competition to increase in the 4 largest metro areas.

3 Ways Tennesseans’ Poor Health Hurts Our Economy & Workforce Development

Many attributes make Tennessee an attractive place to start, move, or grow a business. Tennesseans’ health is not one of them.

How Socioeconomic Factors Affect Health in Tennessee

Prosperity and health are closely connected. Here’s how Tennesseans’ income, wealth, education, and other socioeconomic factors influence our health.

TN’s Next Governor Will Probably Face a Recession

When that recession comes, the governor’s options could prove more limited than in years past. Tough decisions lie ahead.

What Is Tennessee’s State-Funded Primary Care Safety Net?

It includes 4 types of health care providers focused on services that help uninsured adults avoid more costly hospitalizations.

2 Reasons TN’s Obamacare Premiums Might Stabilize in 2019 and 1 Reason They May Not

TN’s Obamacare premiums have risen sharply in recent years, but one insurer says their rates might not change much in 2019. So what’s going on?

County-Level Data on Tennessee’s 2018 Obamacare Enrollment

These maps, charts, and table show how 2018 enrollment, subsidies, and premiums in Tennessee’s Obamacare marketplace vary by county.

Tennessee’s 2018 Obamacare Enrollment

Enrollment appears to be leveling out and the lowest-premium plans have become increasingly popular — but there’s a dramatic difference in premiums paid by subsidized and unsubsidized enrollees.

Who Is Exempt from Proposed TennCare Work Requirements?

Supporters and opponents of a proposed TennCare work requirement have disagreed about who would be exempt. This post attempts to bring some clarity to that debate.

Medicaid Expansion 101 & 6 Lessons for Tennessee

Tennessee can learn from other states’ experiences with Medicaid expansion.

TennCare Work Requirements: 4 Things We’ve Learned from Legislative Action

TennCare expects work requirements to affect about 86,000 enrollees and cost the state $18.7 million per year.

6 Insights for the Debate over TennCare Work Requirements

If the proposed TennCare work requirement is to achieve its goals, our research shows there are several key issues policymakers may want to consider.

5 for TN: Health, Budget, Opioids, the Economy & TennCare

Five 1-page infographics on issues that affect Tennesseans in 2018.

The Budget in Brief: Summary of Gov. Haslam’s FY 2018-2019 Recommended Budget

Find out where the money comes from, where it goes, and what changed from the current budget.

How Uninsured Rates in Tennessee Counties Vary by Employment and Income

Some Tennesseans are more likely to have health insurance than others. Here’s how uninsured rates in Tennessee counties vary after accounting for employment status and income.

Digesting the Feds’ New Guidance & 1st Approval of Medicaid Work Requirements

On January 11, 2018, the federal government released new guidance for states considering a Medicaid work requirement. One day later, Kentucky became the first state to get federal approval.

Healthy Debate 2018: Challenges on the Horizon

The opioid epidemic, recession readiness, and potential reforms and funding pressures from Congress that could affect the state budget.

Healthy Debate 2018: Connections Between Tennessee’s Budget, Economy, and Health and Well-Being

Health, prosperity, public policy…all of these things are connected.

Healthy Debate 2018: Health and Well-Being in Tennessee

To improve our state’s health outcomes, policymakers should understand the complex set of factors that influence them.

Healthy Debate 2018: A Primer on Health & Budget Policy in Tennessee

A resource for any Tennessean who hopes to make or influence public policy in our state.

How Education Influences Health in Tennessee

Health and education are mutually influential. Both health and education policy may benefit from discussions that consider their close and complex connections.

Medicaid Work Requirements in TN (3 of 3): Key Considerations for Policymakers

Defining the goals and details of a TennCare work requirement, seeking better data, investments in support services, and avoiding unintended consequences.

Medicaid Work Requirements in TN (2 of 3): Lessons from TN’s Welfare-to-Work Experience

Those weighing the trade-offs of adding a work requirement to TennCare may look for insights in Tennesee’s experience with the welfare-to-work policies of Families First.

The Economic Impact of Chronic Disease in Tennessee

Tennessee’s excess burden of 3 chronic diseases cost nearly $5.3 billion in 2015 in direct medical care, lost productivity, and premature death.

Tennessee’s Opioid Crisis in 640 Words

Don’t have time to read our 3-part series on Tennessee’s opioid crisis? We wrote up the Cliffs Notes in a new op-ed for The Tennessean.

Health Insurance Coverage in Tennessee in 2016

The U.S. Census Bureau released new data on health insurance coverage across the country in 2016. Here are our top 3 takeaways for Tennessee.

CSR Payments, Uncertainty, and Tennessee’s 2018 ACA Marketplace

Congress & President Trump have 4 options to address CSR payments. Their choice will have a significant effect on Tennessee’s Obamacare marketplace.

Graham-Cassidy’s Impact on Tennessee

The Graham-Cassidy bill gives Tennessee 3 things: more money for health coverage, more control over health insurance, and 18 months to sort out the details.

Medicaid Work Requirements in TN (1 of 3): What, Why, and Who?

Medicaid work requirements are most likely to affect non-elderly adults without disabilities. Let’s look at what that could mean in Tennessee.

What Are TennCare Long-Term Services and Supports?

TennCare long-term services and supports help elderly or disabled low-income Tennesseans with daily tasks like eating, bathing, and taking medication.

Medicaid Eligibility in Tennessee

Can anyone with income below a certain threshold enroll in Medicaid? That’s true in some states, but Medicaid eligibility in Tennessee is more complicated.

The Opioid Epidemic in TN (3 of 3): The Environment for Prevention and Treatment

Tennessee’s capacity for addiction treatment is lower than the demand and out of sync with the geography of the opioid epidemic.

The Opioid Epidemic in TN (2 of 3): Background on Reducing Demand for Opioids

Tennessee has responded to the opioid epidemic by limiting the supply of prescriptions. Reducing demand means addressing addiction.

The Opioid Epidemic in TN (1 of 3): Key Policy Milestones and Indicators of Progress

The opioid epidemic has hit Tennessee especially hard. Tennessee has made progress in reducing opioid prescriptions, but overdose deaths continue to rise.

Employer-Sponsored Health Insurance Deductibles in Tennessee

Employer-sponsored health insurance deductibles in Tennessee have become far more common and far more expensive since 2002.

Options for Stabilizing Tennessee’s Individual Market

If Congress’ health care bill stalls, Tennessee has several options options that might help reduce premium growth and stabilize the individual market.

How Changes to Essential Health Benefits Could Affect Tennessee

The U.S. House and Senate’s health care bills both loosen rules for essential health benefits (EHB), but in different ways and with different trade-offs.

Cardiovascular Disease Mortality Rates in Tennessee

The rate of Tennesseans dying from cardiovascular disease has fallen but remains above the national average. It’s even higher for African-Americans.

How Childhood Experiences Affect Lifelong Health

The science of adverse childhood experiences (ACEs) indicates that early childhood and adolescence are critical times for human brain development.

Comparing TennCare Spending Growth to the Caps Proposed by Congress

TennCare per enrollee spending has usually grown faster than general inflation, closer to medical inflation & slower than medical inflation +1% since 2006.

The American Health Care Act: Rural Health & Tennesseans with Disabilities

The AHCA’s key trade-offs could have a significant impact on 1.5 million rural Tennesseans and 150,000 Tennesseans with disabilities covered by TennCare.

Understanding the Supplemental Nutrition Assistance Program (SNAP)

The Supplemental Nutrition Assistance Program (SNAP), commonly known as food stamps, is one of the primary government programs focused on nutrition.

Understanding Medicaid and TennCare

TennCare is the name for Medicaid in Tennessee. TennCare is the state budget’s largest department, but the federal government pays two-thirds of the cost.

Food Insecurity and Obesity in Tennessee

Exploring and explaining the surprising connection between food insecurity and obesity in Tennessee and the U.S. as a whole.

Two Ways to Approach the Complex Relationship Between Public Health and Public Policy

There’s a complicated relationship between public health and public policy, which makes the challenging task of developing effective policy even harder.

How the U.S. House Health Bill Affects Tennessee

The American Health Care Act (AHCA) could affect coverage for 1 in 3 Tennesseans and give state lawmakers more control over health insurance.

5 Ways Public Policy Impacts Health

A wide range of public policy issues — even some not usually associated with health — can influence the health and well-being of Tennesseans.

Summary of Governor Haslam’s FY 2017-2018 Amended Budget

Governor Haslam’s 2017 Tennessee budget amendment makes a number of changes to the original budget recommendation he released in January.

The Housing and Health Connection

A review of research on the connection between affordable, quality housing and health, with a focus on housing and health in Tennessee.

Comparing Annual Changes in Gas Tax Revenue and Car Sales

Lawmakers considering gas tax revenue and car sales taxes to fund highway projects in Tennessee should weigh the trade-offs of both options.

Tennessee’s High-Risk Pool Experience

The history of AccessTN, the high-risk pool Tennessee created in 2006 in an effort to provide better access to health insurance for high-risk individuals.

Reinsurance & High-Risk Pools

Tennessee may be eligible for federal funding of reinsurance and high-risk pools, which could improve access to health insurance and alleviate rising costs.

Health Insurance Markets 101

An intro to key concepts that influence access and affordability in health insurance markets, such as risk pools, predictability, incentives, and stability.

An Update on the IMPROVE Act – The Senate Transportation Committee Compromise

The Senate compromise on Gov. Haslam’s IMPROVE Act makes the original bill’s Highway Fund tax increases smaller and its General Fund tax reductions larger.

AHCA vs ACA: Tax Credits, Insurance Premiums, and the Big Picture

Tennessee’s individual health insurance market could look a lot different if the American Health Care Act (AHCA) replaces the Affordable Care Act (ACA).

Medicaid Reform 101: Key TennCare Reform Design Elements

Background on TennCare reform efforts and the key design choices Tennessee policymakers may have to address if Congress changes the structure of Medicaid.

TennCare’s Federal Funding under the AHCA

Under the American Health Care Act (AHCA), federal TennCare funding could be $460 million more to $2.6 billion less than current law over the next decade.

How U.S. House Medicaid Reforms Could Impact TennCare

The American Health Care Act (AHCA) being considered by Congress would have a significant impact on federal funding for TennCare.

Op-Ed: Let Data Drive Tennessee Transportation Debate

Good data and research are critical to any public policy discussion. In an op-ed for The Tennessean, we put current transportation issues in context.

The Budget in Brief: Governor Haslam’s FY 2017-2018 Tennessee Budget Proposal

A detailed summary and analysis of Governor Bill Haslam’s 2017 Tennessee budget proposal with charts, graphs and a 1-page infographic.

How Transportation Impacts Public Health

Transportation impacts public health in many ways. Highways, roads, bridges, bikeways, sidewalks, and public transit all have benefits and trade-offs.

Medicaid Reform 101: Key Terms to Know

What’s the difference between Medicaid and Medicare? What’s TennCare? Those are just three of important terms to know as lawmakers consider reforms.

Medicaid Reform 101: More Than Just Block Grants

A 5-part series to explain recent Medicaid reform proposals, including block grants, and how they could impact Tennessee and TennCare.

Tennessee Highway Fund Fact Sheet

Charts & graphs about the Tennessee Highway Fund – where the money comes from, how funding and Tennessee’s gas tax have changed over time, and other trends.

Budget Reconciliation & the Affordable Care Act

The federal budget reconciliation process, how it could be used to change the Affordable Care Act, and how that might impact Tennessee.