State Representative Bryan Terry

What to expect in 2020 legislative session- refugees, cannabis, healthcare, taxes & more

By

Dr. Bryan TerryWith the 2020 Tennessee General Assembly session upon us, I wanted to take the opportunity to give District 48 and others that are interested a preview of what I see coming down the legislative pike this session.  Having knocked on tons of doors, talked with a multitude of constituents, received feedback on my legislative survey, and having spoken to leadership, I’ve compiled a list of several of these issues.

Refugees:

One of the top issues that I’ve received emails about is concern over the refugee resettlement decision by Governor Bill Lee.  To refresh everyone’s memory, the General Assembly put forth a lawsuit exercising our 10th Amendment right to control not only who is relocated to our state, but how our state tax dollars are used.  Unlimited and poorly screened refugee resettlement into Tennessee enriches those companies who place refugees at the expense of Tennessee taxpayers and strains community resources.  

President Trump, to his credit, has worked on improving the screening of refugees and decreased the numbers from around 100,000 to 18,000.  He, then, issued a Presidential Executive Order that allowed a governor’s the sole discretion to decide whether their respective states would participate in refugee resettlement.  Part of that executive order, also, allowed county executives to determine if their counties would accept refugees if their governor elected to participate.

Prior to Governor Lee’s decision, I took the opportunity to speak to our House leadership and members of the Lee Administration to voice my opposition to continuing refugee resettlement in Tennessee and in particular to Rutherford County at this time.  While I appreciate President Trump’s 10th Amendment approach and the need to relocate persecuted refugees, to me, a decision to continue relocating refugees into Tennessee would undermine two important constituent related issues.

First, in my opinion, it would send the wrong message by undermining the lawsuit set forth by the General Assembly.  If part of our argument with the lawsuit involves unfunded mandates from the federal placement of refugees into Tennessee, then agreeing to accept more refugees sends the message that using state dollars to fund a federal program isn’t a problem for Tennessee.

Secondly, Rutherford County and Murfreesboro have just significantly raised property taxes due to unrestrained growth.  Adding more individuals that absorb local resources does not benefit our taxpayers. Even though our county executive has been given the authority to refuse to accept placement of these refugees, any acceptance of refugees that absorbs state dollars, by default, takes funds from taxpayers.

There is a bill that has been filed that places restrictions on the process for counties to accept refugees. I’ve met with legal services and I’m told that the bill is likely unconstitutional.  There are other pieces of legislation being explored. I’ll continue to oppose the policy for constituents and work for solutions that will work for our district.

Temporary Assistance for Needy Families(TANF):

Due to the improved economy and conservative leadership, the number of Tennesseans needing TANF assistance has decreased from around 61,000 to 21,000.  The federal government block grants $191 million per year to Tennessee in a reimbursement grant for TANF. That means Tennessee must spend our own funds and then get reimbursed by the feds.

Tennessee went from overspending our grant by $50-60 million per year to running a $120 million surplus.  As such, Tennessee has built a $732 million dollar reserve. This information was not readily distributed to the General Assembly by DHS, but was brought to light by the Beacon Center.

Immediately upon hearing from the Beacon Center, I contacted them to begin to address the issue as I firmly believe that Tennessee was missing an opportunity to help Tennesseans move from poverty to prosperity.  As I led on this issue, I was named to a bicameral working group to address the issue and subsequently I was elected chairman of that committee. We are working to determine the best way to utilize the funds in a fiscally responsible manner including opioid treatment, workforce development, and other measures.  

TennCare Block Grants:

Tennessee is currently $6.8 billion dollars below our budget neutrality cap for Medicaid.  And though this saves Tennessee taxpayers $2.4 billion dollars a year(fed portion is 4.4 billion), it signals a significant underpayment to hospitals and providers, especially in rural areas.  In essence, what this means is that, over the past 10 years, there has been $54 billion in underpayment to hospitals and providers, particularly in rural areas and we are looking at potentially a greater than 68 billion underpayment over the next 10 years.

The block grant proposal is not a traditional block grant, but would allow for growth if the TennCare population grew.  However, the waiver proposal has the potential to bring in $550 million more in federal dollars to TennCare without raising taxes on Tennesseans.  While bringing in extra federal funds would be beneficial to Tennessee, I’m not completely sold on the waiver because TennCare has consistently made decisions that I believe are not beneficial to patients and I’m not convinced that TennCare would utilize the $550 million in the most productive manner.  We will be awaiting the federal response.

Clinical Cannabis:

Over the summer and fall, I go door to door talking with folks and handing out surveys.  I’ll, also, mail out surveys, as well. It’s one of my ways of keeping my finger on the pulse of the district.

The survey certainly isn’t scientific, but provides me with feedback from the community and an opportunity to listen.  One subset of the community that I have targeted on the issue of medical or clinical cannabis is Republican Primary voters.  In a survey from a previous year, this subsection responded with a ratio of 85/15% in favor of legalizing cannabis in either a clinical or recreational manner.  15% opposed any and all cannabis legalization including research or in clinical settings.

This year’s results were more profound.  A full 95% of those that responded in this group were in favor of legalizing cannabis for at least clinical or research purposes.  Of that 95%, a little over 21% were for recreational uses. Only 5% were opposed to any and all uses of cannabis.  

Let me repeat that.  95% of Republican Primary voters who responded to my survey were supportive of clinical uses of cannabis(research or medical uses).  Again, the survey certainly isn’t scientific and there are more precise ways to measure results, but these results are pretty profound.  

The Alabama commission overwhelmingly recommended that Alabama move forward with legalizing and regulating the medical use of cannabis.  I’ve been working diligently to draft legislation that will move Tennessee in that same direction where research and clinical uses aren’t prohibited for Tennesseans who may see some benefit.  

Criminal Justice Reform:

Whether it is from the Lee Administration or from leadership, time and time again I hear that criminal justice reform will be a top priority this session.  However, nobody has been able to provide me with specifics. When discussing the issue with constituents, having safe neighborhoods and communities while ensuring that we aren’t wasting taxpayer dollars on non productive incarcerations seems to be the recurring theme.  That is a lofty goal that in concept appears easier said than done. We will know more when the bill filing deadline approaches in February.

That being said, 1/2 ounce of cannabis currently carries a misdemeanor charge.  1/2 ounce of 20% THC cannabis has around 2800 mg of THC. Patients who use FDA approved, lab made THC in the form of the drugs Syndros or Marinol, may use up to 2800-3000 mg per month.  We could save taxpayers over 2 million dollars by decriminalizing patients who use cannabis based treatments with less than or equal to 2800 mg of THC.

Taxes:  

Tennessee is, once again, running a  surplus of revenue and is looking at our options.  A few years ago, Oklahoma cut taxes to the point where they ended up with a billion dollar deficit.  Tennessee does not want to end up in that situation.  

With that being said, Tennessee will be looking at doing away with the Professional Privilege Tax once and for all.  It is a discriminatory and redundant tax on certain professions that already pay licensing fees to the state. In 2019, the General Assembly removed the tax for all professions except for a handful.  Originally, the tax was going to be reduced from $400 to either $100 or $200 per profession. However, in a purely political move, it was determined to remove the taxes for some professions while leaving it intact for others.  The General Assembly should correct this injustice this year.

Additionally, with taxpayers expressing frustration over rising property taxes promoted and passed by counties and municipalities, I expect Tennessee to be looking for solutions that will help our homeowners and taxpayers while ensuring counties and municipalities can deal with the increased burden of growth.  I frequently hear elected officials and politicians proclaim their desire for “smart growth”; yet, their priorities as put forth in their budgets and tax plans do not reflect those stated goals.   

Health Care:

The Tennessee House Republicans began 2019 working on the CARE Plan with included a series of bills and initiatives to help transform health care in Tennessee.  The goals were to interject Consumerism, improve Access, focus on Rural health systems, and Empower patients in their health decisions. Several measures passed and some have been adopted on the federal level.  I expect further initiatives to be introduced including expanding access for patients by reducing the burden of narrow networks promoted by insurance companies, reforming Certificate of Need laws, telemedicine, and working towards solutions for the uninsured.

Education:

In my discussions with leadership, I hear that some form of pay increase for teachers will once again be looked at in the budget.  While Tennessee has taken strides in this area, often, not all of those resources budgeted for pay increases end up in the hands of teachers as LEA’s(Local Education Associations) have had flexibility in how to use those funds.  

I, also, expect the Basic Education Program(BEP) formula to be revisited.  The BEP formula is designed to provide LEA’s with state funding for education.  In simple terms, the formula views a county as if it were one giant school, then based on the number of students, it calculates the number of required teachers and ancillary personnel needed to fund the school system.  For instance, for every 100 students, the BEP formula may fund four teachers. Unfortunately, the BEP doesn’t take into account that there are a multitude of schools within each LEA and the school district may have had to hire six teachers for the 100 students.   Growth counties like Rutherford County are at a disadvantage in this calculation.

Social Issues:

Gun rights and pro-life issues will, once again, be on the agenda at the Capitol.  I hear a lot of concern from constituents about Red Flag laws. While someone may put forth a Red Flag bill, I don’t expect one to move in this session.  

Last year, the House passed a Heartbeat bill.  It stalled in the Senate as they decided to send it to summer study.  The bill has been amended and will be heard again in the Senate. Should they pass it, the House will have to confirm or send it to a conference committee.

Bryan Terry Invites Michael J. Fox to Testify On Cannabis Research

By

Chairman Bryan Terry Invites Michael J. Fox to Tennessee to Testify About Cannabis Research
Chairman Bryan Terry Invites Michael J. Fox to Tennessee to Testify
About Cannabis Research

Representative Bryan Terry, MD (R-Murfreesboro), Chairman of the House Health Committee of the 111th Tennessee General Assembly, issued a formal invitation to Michael J. Fox and the Michael J. Fox Foundation, asking that Mr. Fox appear before the House Health Committee during the convening of the 2020 Session to give his testimony regarding the Foundation’s efforts to support expanding research on medical cannabis. 

According to a recent article released by Culture Magazine, the Michael J. Fox Foundation is working to support legislation such as The Medical Cannabis Research Act of 2019, The VA Medical Cannabis Research Act of 2019, and The Expanding Cannabis Research and Information Act. This package of bills will play a crucial role in rescheduling cannabis in order to facilitate the expansion of cannabis research that could provide relief for cancer and pain patients and allow veterans to gain access to relief through the use of cannabis based medicines.

These pieces of legislation on the Federal level correlate with Chairman Terry’s efforts to improve access for patients and development of cannabis based medicines at the state level.  Terry has proposed legislation such as HB 919, which would guarantee Tennesseans the right to participate in cannabis related research programs by allowing them to possess their research medicines in Tennessee, and HB 573, which would add patients with severe cancer pain and inflammatory bowel disease to the medical conditions already allowed to possess 0.9% THC cannabis oils in Tennessee. Also, Chairman Terry’s HB 1011 would create a comprehensive clinical cannabis program designed to help facilitate research in Tennessee for the purpose of developing cannabis based treatments for patients.  Terry’s bills do not allow for smokeable nor recreational uses of cannabis, and aim to decrease the black market by providing patients with safer alternatives in a clinical setting.

In his invitation, Chairman Terry states that “the health of many Tennesseans is being negatively impacted by the existing, restrictive cannabis laws” and that the addition of the voice(s) of the Michael J. Fox Foundation “to the growing support for medical cannabis research would help to convey the urgency for research programs in our state.” Chairman Terry’s goal has always been, and continues to be, focused strictly on safe medical uses for legitimate patients who might, without clinical cannabis based treatments, have no other viable options for relief.  

Chairman Bryan Terry, MD represents Tennessee House District 48, which is the eastern portion of Rutherford County and a portion of Murfreesboro. Terry lives in Murfreesboro and can be reached by email at: Rep.Bryan.Terry@capitol.tn.gov or by calling (615) 741-2180.

Rep. Bryan Terry Publishes 3 Part Series on Opioid Crisis

By

Rep. Bryan Terry Hosts Speaker Beth Harwell For Saint Thomas Rutherford Hospital TourThe opioid crisis is a complex issue impacting Tennesseans of all demographics. Most recently, I opined on the issue in a three part series discussing the supply and demand of opioids including what steps have been taken at the state and where we need to go from here.

Please, follow the links to the articles and feel free to provide me any feedback at BryanTerry4TN@gmail.com

 

 

Part 1 Introduction:

The Supply and Demand of Opioids: An Intricate Dynamic

Part 2 Supply:

The Supply and Demand of Opioids: Tackling the Supply Problem

Part 3 Demand:

The Supply and Demand of Opioids: Tackling the Demand Problem

 

Rep. Terry Talks Block Grants

By

The Lee Administration has proposed an innovative, hybrid block grant solution to better address the unique needs of citizens who utilize TennCare for access to quality healthcare. The proposal is currently under a public comment period.

As a background, TennCare is a 12.7 billion dollar program where there is a 65/35 split in federal/state funding. The federal government provides 65% of the funds and the state supplies the other 35% via a required state match. If enrollment increases, the state must increase spending to meet the funding for additional patients unless the state/MCO’s decrease payment rates to providers and hospitals.

Of note, MediCare often doesn’t pay providers or hospitals the amount necessary to even meet the cost of providing the care to those patients. TennCare, which is Medicaid, pays providers and hospitals significantly less than Medicare, sometimes even 40-60% less. TennCare’s motto promotes high quality, cost efficient care. Providers and hospitals provide TennCare patients the same care as privately insured patients, but, often, at a financial loss. It is because of the low reimbursements from TennCare that the third leg of the health care stool-access- suffers.

In order for providers to keep their medical practices open, they must have a positive payer mix. TennCare, for the most part, does not improve a provider’s payer mix; thus, expanding TennCare in any traditional sense isn’t going to improve a payer mix nor improve access. In order to stay afloat, many providers have to limit the number of TennCare patients that they can or will see. More patients without an improvement in reimbursement isn’t going to change the number of TennCare patients that a provider can see.

While the TennCare program is 12.7 billion dollars, Tennessee is currently 6.8 BILLION under our waiver cap. That means that TennCare saves the government 6.8 billion dollars a year(roughly 4.4 federal and 2.4 state). The state receives “credit” for about 1/4 of that when they look at our waiver. So, one way of looking at TennCare’s efficiency is that the state saves federal and state taxpayers 6.8 billion dollars a year. The other way of looking at it is that TennCare has been underpaying hospitals and providers significantly since its inception-roughly $54 billion alone over the last decade.

The hybrid block grant proposal aims to leverage Tennessee’s efficiency into receiving a portion of the saved federal dollars via a mechanism called “shared savings”. If Tennessee saves the federal government two billion, then we should receive half of that in the form of funding without burdening Tennessee taxpayers with an additional match of 35%. The hybrid proposal, also, has safeguards for Tennessee in that if our enrollment numbers increase, our block grant will increase, as well. Additionally, it includes a yearly increase to keep up with inflation or growth.

The current federal system of Medicaid rewards states that overtax and overgrow their Medicaid system while punishing states like Tennessee that are efficient. A proposal that rewards fiscal soundness and conservativeness should be promoted, not punished. In a world where government waste and taxpayer abuse runs rampant, a proposal that protects taxpayers while ensuring constituent services are protected should be applauded.

Of course, the devil is in the details.  If Tennessee is granted the funds, but expands services or enrollees without addressing the payment disparity, especially amongst rural providers, the block grant will not be addressing the third leg of health care which is access.  Any proposal that does not look to improve payments to hospitals and providers who take a disproportionate number of TennCare patients, particularly in rural areas, will be missing an opportunity to better serve Tennesseans.

That being said, I find it ironic that most of those who advance the idea of Medicaid expansion never look to address the access problem current TennCare recipients have.  They just speak about expanding the rolls without regards to the stress on the system due to the payment disparities that lead to poor payer mixes and restricted available appointments.  Expanding rolls without first addressing the underlying problems does not benefit current recipients nor does it protect taxpayers.

A hybrid block grant, if constructed the correct way, has the potential to help address the payment problems that plague rural providers while, also, helping improve access for current recipients.  If Tennessee can accomplish those goals while protecting Tennessee taxpayers, shouldn’t that option be seriously considered?

I’ve attached an article that discusses the block grant proposal, as well as some of the stakeholder’s comments.

From the article:

“The Lee administration argues TennCare’s managed care approach has already led to an estimated $2 billion in annual cost savings for Uncle Sam over what a traditional fee-for-service Medicaid program would cost the federal government.

So Lee hopes to negotiate a 50/50 split on those and additional cost savings in which the state could reap as much as $1 billion, which Lee hopes to plow into improving rural health care and other initiatives.”

Rep. Bryan Terry: Intricate Dynamic of Opioid Supply & Demand

By

Rep. Bryan Terry Hosts Speaker Beth Harwell For Saint Thomas Rutherford Hospital TourMuch has been opined about the opioid crisis including what caused it, whose fault is it, and what can be done about it.  Across the country, opioid related overdose deaths deceased four percent. Yet, Tennessee’s rate of overdoses continues to climb despite measures taken at the state level.

While many of the measures I have advocated for have passed, some of the more vital measures have not.  The opioid crisis is a multifaceted problem with many intertwined and complicated parts. Unfortunately, many have a myopic view of the issue while others are just looking to do something for the sake of claiming they did something.  Add in that many are advocating for seemingly unrelated issues, and it is easier to understand why this epidemic is a difficult problem to solve.

Understanding the supply and demand dynamics of the opioid crisis can help us find solutions, but it requires those looking for solutions to have open minds and a willingness to step away from failed strategies.  To appreciate the supply and demand dynamics of opioids, one must first understand that there is both a legitimate and illicit demand for and supply of opioids.  

Legitimate demand comes in the form of patients.  Whether it is an acute injury like a broken bone, a perioperative need either before, during, or after surgery, or chronic pain associated with conditions like cancer, failed surgery, or a nerve injury, there is a consistent and endless market for the use of opioids.  And while there are new drugs reaching the market all the time, until one becomes as effective in alleviating pain while minimizing side effects, the demand for opioids will continue.

Ironically, another legitimate demand from patients is that from one that is addicted to opioids.  Patients who are addicted to heroin, fentanyl, or another opioid often undergo treatment in which methadone — another opioid — is often substituted.  Buprenorphine, an agonist that produces opioid effects and an antagonist that blocks certain opioid effects is frequently used for treatment as well.  

Illicit demand comes in several forms.  Obviously, the most common cases involve those who are addicted to opioids.  The process usually begins with initial use that may lead to tolerance, then to dependency and finally addiction.  It may start as a legitimate patient who progresses to addiction or addiction that develops via recreational usage.  Regardless of the route taken, addiction drives much of the illicit demand.

Another form of illicit demand includes those looking for a recreational use.  Whether it is in the form of a party or one looking for a route of escape from reality or a psychological, physical, or emotional trauma, there are those who turn to opioids, which increases demand for the deadly drugs.  

Perhaps, one of the more unfortunate illicit demands for opioids is from legitimate patients who have a physical need, but are under treated or mistreated by the system.  Some patients in chronic pain or with cancer pain may look to alcohol, marijuana, or street opioids in order to function normally.  

As physicians and as legislators, treating patients with a legitimate need for an opioid while preventing or decreasing the illicit demand is where many efforts need to be addressed.  Decreasing the risk for patients to get on the on ramp to addiction is vitally important; it is just as important to prevent those who have gotten off the addiction highway from getting back on by ensuring there is proper addiction treatment available.  

The supply side also has a legitimate and an illicit aspect.  Legitimate supply comes in the form of a prescription from a medical related need by a patient.  Opioids are supplied via a doctor, pharmacy, or hospital. Real patients with legitimate needs delivered in a safe, and effective manner drives much of the supply side of opioids.

Unfortunately, the legitimate supply side has been contaminated by the government, big pharma, and unscrupulous providers leading to an oversupply of unnecessary opioids into the marketplace.  The government, by making pain the fifth vital sign, tying Medicare payments to patient satisfaction surveys, and instituting laws like the Intractable Pain Treatment Act didn’t just incentivize prescribing opioids, they mandated it.  Big Pharma pushed controlled release opioids like OxyContin as a safer alternative, and many providers abused the new medical landscape placing pain profit over patients.  

The illicit supply side of opioids involves two main sources: diversion or the selling or distribution of FDA approved opioids, as well as the trafficking of illicitly manufactured opioids.  Unused prescription opioids and addiction treatment opioids are being sold on our streets or used in a recreational setting, and it has been a major concern in their illicit supply.

While appropriate and inappropriate uses of FDA approved opioids are a major concern, especially when mixed with other drugs, it is the trafficking of illicit opioids like heroin, fentanyl, and carfentanil that should scare people.  As an anesthesiologist, I treat patients with fentanyl almost every day. For its indicated use and under the right medical direction, it is a valuable tool. However, when traffickers can possess millions of lethal doses and push it into our communities, it becomes a major health concern.  To make matters worse, many of these illicit opioids are being manufactured in China and wind up in our communities through Mexico.  

As one can see, the supply and demand side of the opioid equation is quite intricate.  If we truly want to be able to address this complex issue, focusing on one aspect while avoiding or neglecting the others will ultimately lead to failure.  It is going to take a multifaceted approach with a willingness to attack all sides of the supply and demand equation to get Tennessee on the pathway to a better tomorrow.

Bryan Terry, MD (R-Murfreesboro) is the Chairman of the Tennessee House Health Committee.  This is Part One of a two part series on Opioids: Supply and Demand.

Rep. Bryan Terry Pushing For Rutherford Co. DMV Solutions

By

Folks, I wanted to give the community an update on what has been going on with the DMV and ask for community input as we move into next year’s session.  As I have been investigating the issues, a couple of stories have come about that highlight some of the issues at our driver’s service centers across the state.

HOW BAD ARE TENNESSEE DMV WAIT TIMES? 

AUDIT: NON-RESIDENTS GETTING TENNESSEE DRIVERS’ LICENSES 

As many know, we have a driver’s service center(DMV) located off Middle Tennessee Blvd.  They provide driving permits, driver’s licenses, road testing, renewals, handgun permits, and now they have Real ID.  We, also, have three renewal kiosks located in Rutherford County.

Nobody enjoys going to the DMV.  Nobody wants to wait. Nobody who values their health points to the DMV and demands a DMV style government run health care system.  It is an essential government service that everyone points to as a prime example of government inefficiency. Despite upgrades or changes, it always seems as if the system is still behind.  

Over the past few weeks, I’ve been investigating some issues that have cropped up.  Ironically, the economy is booming and our labor market has gotten tight. For employees, it is great in that wages have risen, and employees are in high demand in the workplace.  For those hiring, including the government, it means one has to look for solutions in order to offer a productive and efficient service.

Between emails, phones calls and meetings with the Department of Safety, Governor Lee’s office, our Speaker and Finance chair, and leadership, I have been looking for some solutions that could benefit our citizens.  As I’ve described my four step process on issues before, I wanted to explain my process on this issue.

PREMISE OR PROBLEM

Our DMV has been experiencing extended delays for services, including in the office and road test services.  While this premise or problem seems to be the standard operating procedure for a DMV, we have seen a recent worsening of this problem.  

A few years ago, I looked into the issue.  What I discovered was that the state average wait for a road test was 12 days while Rutherford County was around 18 days.  Some options were floated, but the direction the Department of Safety wanted to take was to offload services from the DMV site either via kiosks or having counties oversee some of the services.  

Rutherford County did not participate in absorbing some of these services.  With a tight county budget and personnel restrictions, I certainly understand the decision.  (As an aside, Lisa Duke Crowell is doing an admirable job and is willing to work for solutions.  She has the interest of our constituents and taxpayers in mind.). 

In the end, the Department of Safety placed three kiosks in Rutherford County.  These kiosks help with renewals and are located at Middle Tennessee State University, the Murfreesboro Driver Services Center, and Rutherford County Clerk (Smyrna).  

Currently, there are three acute problems occurring at our DMV.  First, is personnel. We are supposed to have 8.5 full time equivalent employees at the center.  Unfortunately, we are down 3 employees due to vacancies. The Dept. Of Safety has increased their salaries and has hired 3 people to fill the vacancies, but they haven’t started yet.  Additionally, I have been told that our DMV recently had a person on vacation, one out for surgery, and one sick. They were down to 2.5 employees which backed things up considerably.

In today’s job market, it is difficult to attract employees to work in a DMV.  It is a thankless job that has high turnover. Ironically, as I discuss turnover and vacancy issues, one of the individuals with the department that supplied me with information is no longer there.

Secondly, with Real ID coming into fruition, we have had an influx of people needing new IDs at the DMV.  There are kiosks in the county to offload renewals, but that doesn’t help with new or real ID’s. Thirdly, gun permits have increased, as well.  

We aren’t the only center having issues.  There are 43 other centers in Tennessee like our center in Murfreesboro.  Statewide, there are 29 vacancies. In addition, statewide there is a road testing average wait time of 11 days.  Unfortunately, Rutherford County seems to be hit exceedingly hard. We have 10% of the vacancies and our road testing wait time is 28 days.  Only the East Shelby County Driver’s Center has a longer wait at 29 days.

GOALS

Obviously, the goal should be to provide an efficient public service to the community in a cost efficient manner.   

OPTIONS

Self-governance is the cornerstone of our republic.  So, I am more than open to listening to any options that may be presented.  Please, contact my office if you have any. That being said, I’ve been having discussions on three basic options.  Understand that the Department of Safety has given raises to employees, but that still hasn’t resolved the issue.

First, the Department of Safety is continuing to look at offloading services from the main office.  They are partnering with County Clerk Office’s to have county government provide some of the services.  Many counties have joined in the partnership. Rutherford County has not, as of yet. Secondly, adding more kiosks may allow for decreasing demand at the service center.

Third, with high turnover and need to cover vacancies, vacations, and sick leave, starting a float pool to either work in the office or provide road testing is an option that I have discussed with the Department of Safety and the Lee Administration.

FEASIBILITY 

Without significant financial outlay from the state to Rutherford County, it will be difficult for our county to participate in a partnership.  With a tight county budget, personnel restrictions, and on the heels of a county tax increase, asking the county to foot the bill doesn’t seem feasible.  

With a greater than 600 million dollar surplus, Tennessee should have significant non-recurring and recurring funds.  Non-recurring funds could help with setting up more kiosks. Recurring funds could help with setting up and running a float pool.

CONCLUSION 

The Department of Safety will be presenting their budget requests to the Governor soon.  For our citizens, these services are a priority, and I’m pushing for them to address the concerns of our growing county.

As always, I’m honored that you allow me to serve.

With Liberty,

Rep. Bryan Terry, MD

Speaker Sexton Reappoints Rep. Bryan Terry As House Health Committee Chairman

By

(NASHVILLE, Tenn.) — Tennessee House Speaker Cameron Sexton (R-Crossville) reappointed State Representative Bryan Terry, MD (R-Murfreesboro) to chair the House Health Committee during the General Assembly Special Session conducted August 23.

The committee is responsible for all legislation dealing with healthcare including private and public hospitals, health offices and their administrations, as well as institutions and services.  As full committee chairman, Terry will continue to oversee three health subcommittees: Public Health, Mental Health and Substance Abuse, and Facilities, Licensure, and Regulations.

“Dr. Terry is committed to improving the health and well-being of all Tennesseans, and he is the right person to continue leading our House Health Committee,” said Speaker Sexton. “I appreciate his willingness to serve in this important leadership position, and I know he and his colleagues will enhance healthcare in our state.”

During the 2019 legislative session, Dr. Terry was one of the co-architects of the historic and innovative CARE Plan, which was unveiled during the 2019 legislative session by House Republicans. This plan is designed to transform healthcare in Tennessee by creating a patient-centered approach to improve access and the quality of care available to our citizens through Consumerism, increasing Access, improving Rural health systems, and Empowering patients. This will ensure individuals and families can make medical decisions with limited interference from insurance companies or the government.

“Tennesseans need a system of health care that focuses on patients, improves access and the quality of care available, and lowers overall costs,” said Dr. Terry. “As Chairman of the House Health Committee and an author of the CARE Plan, I remain committed to achieving these outcomes, and I am eager to build upon our recent efforts to make Tennessee a national leader on this important issue.”   

Bryan Terry, MD represents Tennessee House District 48, which includes a portion of Rutherford County. Terry lives in Murfreesboro and can be reached by email at: Rep.Bryan.Terry@capitol.tn.gov or by calling (615) 741-2180.

Representative Bryan Terry Fights To Support Tennessee’s Strong Economy

By

(Nashville, Tenn.) — Throughout his time serving in the Tennessee General Assembly, State Representative Bryan Terry (R-Murfreesboro) has fought to make Tennessee an attractive destination for businesses and for families.

By supporting legislation that strengthens our business-friendly environments, cutting taxes, and eliminating burdensome, job-killing regulations, Terry and his Republican colleagues have ensured Tennessee’s unemployment rate remains near historic low levels — just 3.4 percent as of June 2019.

U.S. News recently ranked Tennessee No.1 in their report for Best States for Fiscal Stability while Business Facilities Magazine recognized Tennessee as having the best business climate.  

“Our conservative, job friendly policies are helping Tennessee attract and grow businesses.  We’re seeing businesses move to Tennessee from other states while also seeing Tennesseans open new businesses,” stated Terry.  “Business leaders are showing confidence in Tennessee and it is reflected in our strong economy.”

With low unemployment rates and a strong business climate, Tennessee’s average median household income is growing at the second fastest rate in the entire southeast.  The average private business hourly wage has grown in Tennessee and is hovering around $24 per hour without the regulatory endangerment of a $15 an hour minimum wage mandate. 

“Tennessee is rising to the task of better jobs and wages without resorting to added regulatory burdens and legislative mandates that are counterproductive. However, this is just one piece of the puzzle to improve the quality of life for Tennesseans,” stated Terry. “Families and businesses prioritize various attributes of a community or state when looking to grow a business or raise a family.  I am working diligently with my colleagues to address these other elements like health, safety, and quality education.”

While not often cited as the main deciding factor for family and business location, access to recreation and leisure activities often plays a pivotal role.  Industries such as leisure, hospitality, and tourism, tend to thrive in healthy economic areas like Tennessee. The tourism industry — which currently employs 189,757 citizens and accounts for 6 percent of all jobs — generated over $1.8 billion in state and local revenue alone last year. That is a $50 million increase for the state over the previous year.

“Our economy is firing on all cylinders right now, and new companies are relocating to Tennessee every day. Clearly, Tennessee tourism and the hospitality industry are key components to our overall success, and my colleagues and I will continue to support those employed through these and all of our industries. Under Republican leadership, Tennessee will remain the best place in the entire nation to live, work, raise a family, and retire,” Terry concluded.

Bryan Terry, MD serves as Chairman of the House Health Committee. He is also a member of the House Insurance and the House Calendar & Rules Committees, as well as the Facilities, Licensure & Regulations, Mental Health, Public Health, and TennCare Subcommittees. Terry lives in Murfreesboro and represents Tennessee House District 48, which includes a portion of Rutherford County. He can be reached by email at: Rep.Bryan.Terry@capitol.tn.gov or by calling (615) 741-2180.

Rep. Bryan Terry Touts House GOP Election of Speaker-Select Sexton

By

On Wednesday, Representative Cameron Sexton (R-Crossville) was elected by the Tennessee House Republican Caucus as Speaker-Select to replace Glen Casada (R-Franklin) who is set to resign his position as Speaker next month.  Representative Bryan Terry, MD (R-Murfreesboro) lauded the choice of Sexton and touted his selection as being a positive for Tennessee and Rutherford County.

“Cameron Sexton and I have been side by side fighting for Tennesseans on many issues including the House Republican CARE Plan and opioid-related bills.  Working closely with him as committee chairmen and on the House floor gives me a unique perspective that not all have seen,” explained Terry. “When looking for a Speaker that can help Tennessee, Rutherford County, and District 48, while helping our caucus move forward, one needs a person that can check all those boxes.  I believe we are getting that in Speaker-Select Sexton.”  

Sexton and Terry previously served together as Health Committee Chairman and Subcommittee Chairman respectively under former Speaker Beth Harwell.  Together, they formed a formidable team known around the Capitol as patient advocates and for their relentless efforts in addressing the opioid crisis.  They were two of the key members in formulating the CARE Plan, which has laid the foundation for injecting consumerism and empowering patients into the Tennessee health care system.

Sexton, who currently serves as the Republican Caucus Chairman, was chosen amongst six Republican candidates during a caucus election held Wednesday in the Old Supreme Court Chamber at the Capitol.  He ran on a platform of effective leadership through leading by example and empowering legislators via legislative, messaging, and fundraising support.  

“Having served as Majority Whip, Caucus Chairman, and Chairman of Health has provided me with the experience needed to be an effective Speaker,” stated Sexton.  “Ultimately, it is about the House members and the constituents of Tennessee.  Helping legislators with their constituents like I can do with Dr. Terry each day is what we need as the House moves forward.  I appreciate the faith our caucus has instilled in me, and I am looking forward to the challenges ahead, and to continue working with great legislators like Dr. Terry.”

As Republicans hold a supermajority in the House, Sexton is expected to be overwhelming chosen as the next Speaker of the House when the Tennessee General Assembly reconvenes for a Special Session on August 23.  

“If my time and experience working with Sexton is any indication of things to come, then his election will be a positive for Tennesseans, Rutherford County, and patients.  Our caucus is ready to move forward and continue to do great work for Tennessee with him as our Speaker,” concluded Terry.

Rep. Bryan Terry Works To Improve Healthcare

By

Rep. Bryan Terry Hosts Speaker Beth Harwell For Saint Thomas Rutherford Hospital Tour

NASHVILLE, JULY 8, 2019– Representative Bryan Terry (R-Murfreesboro) recently sent letters to the Centers for Medicare & Medicaid Services (CMS) on behalf of District 48 and the Tennessee House Health Committee for support of a new proposed federal rule that would help improve the financial situation of Tennessee hospitals.  The rule would adjust the formula for calculating the Medicare Area Wage Index (AWI) which would improve payments to Tennessee hospitals and help stabilize the health care market.

“Because Medicare payments are predicated on the Area Wage Index and the AWI for Tennessee is low, our hospitals, especially our rural hospitals and those located in East Tennessee, are placed at a significant financial disadvantage compared to other states,” explained Terry.  “While medical equipment, supplies, and medications have continued to climb, Tennessee’s AWI has not. Hopefully, CMS will fix this disparity.”

Currently, every county in the State of Tennessee falls below the area wage index. This places Tennessee at a rank that is near the bottom of the reimbursement ranks in the country and has created a financial problem for hospitals in Tennessee.  The relief CMS has proposed in this rule will help keep more Tennessee hospitals from shutting down, and it will help keep healthcare access open for our citizens.

As Chairman of the Health Committee, Terry worked with the Tennessee Hospital Association, members of his committee, and other groups to address this problem.  In his letters, he pointed out that the structural make-up of AWI created a cycle that has led to the downfall of Tennessee’s reimbursement rate over the last 15 years. He emphasized that the proposed rule by CMS, CMS- 1716-P, would allow a beneficial plan to resolve the wage index disparities for hospitals with a wage index value below the 25th percentile, and would check the abuses of the “rural floor” calculation seen in other states.

“Medicare often doesn’t even pay enough to cover the costs to provide a service.  TennCare often pays significantly less than Medicare. This problem has to be addressed if we want to recruit doctors and services that will keep our hospitals afloat,” stated Terry.  “While this rule change won’t solve every problem in health care, it is a necessary step.”

In addition to addressing the AWI, Terry has been actively working on legislation within the House Republican CARE Plan which is aimed at decreasing costs and improving consumer driven care.  He has, also, been working to increase efficiency with TennCare while looking to help Tennessee take advantage of the State Relief and Empowerment Waivers offered by the Trump Administration.

Follow Dr. Terry on Facebook and Twitter.