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For Voters In Appalachian Region, Medical Care Is A Big Issue


And I'm Steve Inskeep in Knoxville, Tenn. We're with a live audience, which came out ridiculously early. Thank you very much, folks.


INSKEEP: We're also here with our friends from WUOT, the Knoxville station. We're getting a view from Appalachia, hearing national issues as they look from here. We've met voters including Nora Connolly (ph), a freshman at The University of Tennessee, Knoxville who had a question for her state's governor.

NORA CONNOLLY: If I could talk to Governor Haslam, I would say that we need to make sure that there is insurance for every Tennessean who needs it. No matter what income level they're born into, no matter what their level of education is, that everybody should be able to get the health care that they need. My dad is a nurse practitioner who works with low income groups, and so that's something that I've kind of been brought up to be - like, it's been very important to everybody in my family.

INSKEEP: All right, we put Nora's question to Governor Bill Haslam, who's Republican. Now, let's remember states could opt in or out of parts of Obamacare. Nearby Kentucky embraced the law, especially expanding Medicare for the poor. Tennessee didn't do that, which has left the governor working to find a substitute that does about the same thing.

BILL HASLAM: I worked hard with the administration in Washington to come up with a plan that they would approve - I spent about 18 months on it - and that I thought I could get passed in Tennessee. And so we got the Washington part done, but I couldn't get it passed in Tennessee. Obviously, I still think it would be - we'd be better off or I wouldn't have proposed that. We'll see. To be honest with you, I think so much around health care today is a reaction to the current president.

INSKEEP: Because of the name.

HASLAM: Well, I won't say totally that. I mean, if one of our legislators in here, they'd give you some other reasons. But I just think it - unfortunately, because it was a part of the Affordable Care Act, it just got very hard for me to drag it across the finish line.

INSKEEP: That's Tennessee's Republican Governor Bill Haslam. We're joined now by the mayor of Knoxville, Tenn. Democrat Madeline Rogero, welcome to the program.



INSKEEP: Let's count that as nonpartisan applause.


INSKEEP: How does it affect your city that Medicaid was not expanded?

ROGERO: Oh, it greatly affects our city. We know there are thousands - tens of thousands of people who are desperately in need of health insurance. And we - I and other big-city mayors across the state push to get people signed up, enrolled in Obamacare. And at those - it was so sad. At those events, people would come up and they didn't actually qualify for Obamacare. But if we had the Medicaid expansion, then they would get insurance. And to watch their tears and disappointment was just heartbreaking.

INSKEEP: Let me ask you about this, though, because as we traveled around the region, we saw evidence to argue both sides of this. We were in Letcher County, Ky. It's very poor. And Kentucky expanded Medicaid. Half the county - half the county is now on Medicaid, the program for the poor. You can say, well, they obviously needed it. It's a poor county. You can also say, wow, that is a huge government obligation. Would you be comfortable if you found that such huge percentages of Tennesseans ended up on Medicaid?

ROGERO: No, I think people need to have benefits from their jobs, number one. And I think more employers need to offer it. So we want people to have the income so they don't qualify. But the reality is there are too many people right now who do qualify. And we need to be offering that to them as a state.

INSKEEP: So what is it like to be a Democrat in a red state?

ROGERO: Actually, look at my constituents out here, you know? It's pretty good (laughter).


INSKEEP: OK, but Democrats have not done so well for years.

ROGERO: No, but, you know, I think the key to this - being a Democrat in a red state - is not working as a Democratic mayor, but as I am elected in a nonpartisan role. And our key to success has been that we're able to reach out. There are Republicans in this room as well, you know?

INSKEEP: You bet.

ROGERO: And so we've been able to work with people across party lines and just work on the issues.

INSKEEP: Let me ask about one specific issue that's come up in the presidential campaign. I don't think it's resonated across the country. But it's resonated here in this region we're focusing on - Appalachia, parts of thirteen states. Lots of coal mining - and that industry is dying in many places. Hillary Clinton, presidential candidate you support, made a remark about coal. I want to hear a little bit of that. She said in a speech that she wanted coal miners to find jobs in renewable energy. And then she added this.


HILLARY CLINTON: We're going to put a lot of coal miners and coal companies out of business. And we're going to make it clear that we don't want to forget those people.

INSKEEP: OK, it sounds like she was trying to say I want to help people. But that line - we're going to put a lot of coal miners and coal companies out of business - hurt a lot of people, when we were traveling around, who knew that line. Let's bring in Chris Green of Berea College, who's been with us all morning. How does that remark resonate in Appalachia?

CHRIS GREEN: It resonates as if people and their heritage and their connections to where they're from aren't respected or known.

INSKEEP: Aren't respected or known - why would that be a matter of heritage? It's business.

GREEN: Well, these are families who - going back four generations as coal miners - from one father - grandfather to grandson.

INSKEEP: Mayor Rogero, do you feel that this is part of the reason that the Democrats have continued for generations now - for several decades - to lose more and more ground in Appalachian states?

ROGERO: Well, I don't think that's the reason. You know, I think the - even in Knoxville in the city, so many of us have extended family members who are in the coal industry. And if you're for sustainability and energy efficiency, a greener environment, we face that struggle, you know, of respecting what our family members and friends and neighbors have done for years but also recognizing that the world is changing and that we need to change with it and provide people the opportunities they need to be able to seek other employment.

INSKEEP: We've got 30 or 40 seconds left. Do you feel you have in your mind a message that your party, in this divided country, can deliver to redder parts of the country?

ROGERO: Well, what I hope my party will deliver is that in order to achieve any advances, we're going to have to work together. We have to get beyond the party ideology and do like we do at the local level. Regardless of our parties, we're working to solve the problems. And we used to do that at the national level, but we just haven't done that recently - you know, in recent - unfortunately a decade or two.

INSKEEP: Mayor Rogero, thanks very much.

ROGERO: Thank you.

INSKEEP: Madeline Rogero, the mayor of Knoxville, Tenn. We're listening to...


INSKEEP: We've also heard from Republican Governor Bill Haslam, many, many voters here. And let's hear just a bit more from Knoxville musician R.B. Morris.

R.B. MORRIS: (Singing) One generation lost to the next. We can't see the future, and we don't look back. It's like we're only able... Transcript provided by NPR, Copyright NPR.