Cempa Community Care, based in Chattanooga, has been battling HIV/AIDS for 37 years. In 2022 alone, its HIV programs served more than 4,000 Tennesseans. Those programs will lose their main source of financial support now that Republican Gov. Bill Lee has announced he’ll reject federal grants for HIV prevention, detection and treatment in Tennessee. As organizations like Cempa scramble for funding, he will leave $8.8 million on the table every year.
Lee’s reported motivation was to target his great white whale, Planned Parenthood, although it doesn’t provide abortions in Tennessee; Cempa got caught in the net. Lee’s stated reason was that he didn’t like the “strings attached” to federal dollars, a favorite Republican excuse for turning that money away.

He’s said he’ll use $9 million in state funds (thus avoiding strings) to combat HIV by prioritizing “vulnerable populations, such as victims of human trafficking, mothers and children, and first responders.”

According to the Foundation for AIDS Research, focusing on those groups would prevent nine cases of HIV a year in Tennessee. Focusing on the four populations most at risk, including gay men and IV drug users, would prevent 509.

History suggests our governor is averse to funding social programs if he views the beneficiaries as morally flawed. We’ve seen this dynamic in action as he’s hoarded federal block grants—Temporary Assistance to Needy Families—intended for Tennessee’s working poor.

TANF, a welfare-to-work program, replaced traditional welfare after Ronald Reagan convinced America that hordes of freeloaders (insert racial subtext) were abusing the system and having babies to milk it more. Reagan’s “welfare queens” were the new sewer alligators: they were terrible and everywhere. They’ve lurked in our collective consciousness since.

Now, rather than sending low-income families welfare checks, the U.S. government sends states TANF funds to disburse how they see fit. Until he got called out for it, Lee saw fit not to disburse them.

During a once-in-a-lifetime pandemic, in a state with the 12th-highest childhood poverty rate, as people were losing their jobs and their homes and lining up outside food banks, Lee was sitting on $730 million in unspent TANF funds and a $2.1 billion budget surplus.

After those jaw-dropping numbers made national news, Lee finally announced some disbursements. Among his first was $5.4 million to combat sex trafficking, including $1.2 million sent out of state to a Christian organization run by Tim Tebow.

That same month, May 2021, Lee announced that Tennessee would pull out early from the federal pandemic unemployment programs keeping millions of Americans afloat. There were plenty of jobs to be had, he explained, not seeming to care that COVID was still forcing impossible calculations: how to go back to waiting tables without bringing the virus home to Grandma, how to return to the office without child care.

I envision Lee’s policy calculations as simple exercises based on two columns in his head. In one are sex-trafficking victims, first responders, babies (preferably in utero) and pregnant women (unless they’re experiencing a medical crisis requiring an abortion). In the other are deviants and weirdos, addicts and criminals, and slackers with their fancy coffee drinks.

But people aren’t that simple. So much depends on our luck and our circumstances, how much money we have, how our brains are wired, even one fateful decision. Who “deserves” government help and who doesn’t?

Basing policy on that question has been costly for Tennessee.

Since 2014, we’ve turned away more than $20 billion in federal incentives to expand Medicaid, which would provide health insurance to around 350,000 Tennesseans. We’re one of just 10 holdout states—all Republican led, almost all in the South.

Apparently to keep some of us from getting something that we don’t deserve, these states have let millions of us go without checkups, go without medical treatment, go broke from medical bills. That’s why Southerners have the worst credit scores in the country. The economic fallout has been calamitous in rural Tennessee, where 13 hospitals closed between 2015 and 2020 alone.

Years of empirical data from other states show that expanding Medicaid has wide-ranging benefits, such as significant reductions in violent crime. If Tennessee had been one of those states, would we still rank third for violent crime and second for bankruptcy? Would we still have some of the nation’s highest rates of heart disease, diabetes and child obesity?

Tennessee is failing by practically every measure related to poverty. Yet Lee launched his second term in office by turning a single economic ranking (first for GDP growth) into a rosy tagline: Leading the Nation. The complicated truth is we have the means, so we have the potential. But unless we stop fretting about strings, we’ll never get there.

Allison Gorman is a writer and editor in Chattanooga, Tenn.

Allison
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