Rural Tennessee needs answers – not promises

Marsha Blackburn's record is clear, but questions remain about vouchers, Medicaid, and rural hospitals. I ask for specifics.

#Opinion • 12:30 p.m. Nov. 3, 2026

An open letter to Governor-elect Marsha Blackburn.

Senator Blackburn:

You've spent nearly three decades helping write the rules. In January, you'll be responsible for making them work.

Here in Moore County, we have some questions about how you intend to do that.

Our public schools serve 937 students across two campuses – Lynchburg Elementary School and Moore County High School. Across Tennessee, 10 rural hospitals have closed since 2015. An August 2026 report found another 19 financially at risk, including 12 facing immediate risk of closure.

These aren't theoretical problems. They're the realities you'll inherit.

You campaigned on expanding school choice, controlling government spending, and improving rural health care. Your congressional voting record stretches back to 2003. Your positions are well documented.

Now we want to know how those positions will translate into state budgets, policies, and results. We aren't looking for another campaign speech.

Education: Show us the math

You've pledged to expand Tennessee's Education Freedom Scholarship program until no parent has to enter a lottery to receive a private-school scholarship.

For the 2026-27 school year, Tennessee offers 35,000 scholarships worth $7,530 each. That's more than $263 million in annual scholarship value at full enrollment.

How many additional scholarships will you authorize, what will they cost, and where will the money come from? You've proposed eliminating government waste to help finance expansion. Which specific expenditures would you cut, and how much would those cuts save?

Tennessee now mandates a $50,000 minimum starting salary for teachers. That requirement applies to Moore County just as it does to Rutherford, Williamson, and Davidson counties. But we have a fraction of their enrollment and tax base.

We can't eliminate a science teacher because a handful of students leave. We can't quit running a bus because ridership drops. And we can't defer building maintenance indefinitely because the funding formula doesn't stretch far enough.

The Tennessee Investment in Student Achievement formula provides additional funding for small and sparsely populated districts. But it doesn't reimburse each school system dollar for dollar for its actual staffing and operating costs.

Will your administration fund the $50,000 teacher salary requirement based on what small districts actually spend, or will counties like Moore be expected to raise taxes or cut elsewhere to cover the difference? If you believe existing TISA funding is sufficient, will you provide the calculations supporting that conclusion?

Tennessee has established temporary protections for districts experiencing enrollment losses. Those protections are conditional and change over time.

If voucher expansion reduces Moore County's enrollment-based funding beyond what the state's existing protections cover, will you replace the difference? For how long, and from which state appropriation? Will you also increase TISA funding for traditional public schools as you expand vouchers?

There's another question you haven't fully answered: accountability.

Public schools must administer state assessments, report academic results, and account for public spending. Private schools receiving voucher money operate under different requirements.

You've defended the current arrangement, arguing that parents provide accountability through their school choices.

Will private schools accepting taxpayer-funded scholarships be required to meet the same testing, financial disclosure, and reporting standards as public schools? If not, what specific standards will you require, and how will taxpayers independently verify academic results and expenditures?

Then there's the reality of school choice in rural Tennessee. The state's 2026-27 roster lists no participating brick-and-mortar private school in Moore County. A scholarship doesn't create a classroom or provide a ride to one.

What will your administration do for families without a participating private school nearby? Will you expand transportation assistance? How will you address tuition costs that exceed the scholarship amount?

You've repeatedly said parents deserve choices. We want to know how that promise will work for families who live miles from the nearest participating school.

Rural health care: Follow the money

Your voting record raises another set of questions.

In 2010, you voted against the Affordable Care Act. In 2017, you voted for legislation that would have repealed major provisions of the ACA and substantially reduced projected federal Medicaid spending.

On July 1, 2025, you voted for a federal budget law that the Congressional Budget Office projected would reduce Medicaid spending by nearly $1 trillion nationwide over 10 years. That same law established a $50 billion Rural Health Transformation Program. Tennessee was awarded approximately $206.9 million for its first year, an investment you publicly welcomed.

Your record also includes bipartisan efforts to improve rural Medicare reimbursements, expand emergency care, and recruit health professionals. We recognize those efforts. But a grant award and a hospital's operating budget are two different things.

What is your estimate of the revenue Tennessee hospitals will lose under the Medicaid changes you voted for in 2025? Which rural hospitals face the greatest financial exposure, and how would you offset those losses?

And of Tennessee's nearly $207 million first-year rural health award, how much has been awarded directly to hospitals? How much have they actually received? Will you publish a hospital-by-hospital accounting that separates money awarded from money paid?

The federal program is funded for five years. Future annual allocations aren't guaranteed to match the first year's award. When that funding ends, what recurring revenue will sustain the services and improvements it financed?

Now, Medicaid expansion. Tennessee remains among the states that have declined to expand Medicaid eligibility under the ACA. You've historically opposed expansion. When asked during the 2026 campaign whether you would support it as governor, you discussed telehealth, rural hospitals, and alternative care models without giving a direct answer.

So we'll ask again: Will you support expanding TennCare eligibility under the Affordable Care Act? Yes or no?

If the answer is no, what specific alternative will you pursue to cover uninsured working Tennesseans and reduce uncompensated care at rural hospitals? How many people would it cover, what would it cost, and where would the funding come from?

You've also advocated for freestanding rural emergency departments. Those facilities can stabilize patients and treat emergencies, but they don't necessarily replace inpatient beds, maternity wards, or the full range of services provided by community hospitals.

What is your plan to keep existing rural hospitals open and preserve those services? Which actions can you take as governor without waiting for Congress, and what measurable results should rural Tennesseans expect by the end of your first term?

You've proposed federal legislation to improve Medicare payments and recruit rural health professionals. But those bills require congressional action.

Tennessee's next governor won't have the luxury of waiting on Washington.

The view from Moore County

We understand these problems didn't begin with you. Rural hospitals have struggled for years, and Tennessee's education funding challenges predate the current voucher program. No single politician created them, and no governor can resolve them overnight.

But you'll soon be responsible for addressing them.

Here in Moore County, we know what it means to work within a budget. We know the difference between money that's been promised and money that's available to pay the bills.

Our school board needs to know whether Nashville will fund the obligations it imposes. Parents need to know whether school choice means an actual opportunity. And rural families need to know whether the nearest hospital will still be there when someone they love needs it.

You spent years casting votes, introducing legislation, and advocating for policies you believe will improve Tennessee. Now comes the harder part: making those policies work.

We know where you've stood. We want to know what you'll do. Give us the numbers. Tell us where the money will come from. Explain how your plans will work in counties like Moore, where resources are limited, but the obligations are no less real.

We're ready to publish your answers, in full.

And when your first state budget arrives, we'll be looking for them there.

Duane Cross
Publisher, Moore County Observer
Lynchburg, Tenn.