Gov. Bill Haslam speaks to a joint session of the Tennessee General Assembly on Wednesday. Image courtesy TN Photo Services
Governor Bill Haslam may have muddied the waters more than anything else with his much-anticipated decision on whether to expand the state’s Medicaid program. He said neither “yes” nor “no,” calling instead for a “third way.”
Haslam revealed Wednesday morning that he has been working for months on a “Tennessee Plan.” It would divert the federal money meant for a Medicaid expansion – $1.4 billion next year – to help people pay for private insurance. He says the Medicaid system is “broken” and doesn’t require recipients to have much skin in the game.
“We don’t think our ask is unreasonable,” Haslam told reporters. “Now, we’re pushing the envelope a little.”
Tennessee follows other red states like Arkansas and Ohio in looking for a middle ground. But so far, the White House hasn’t given the green light for a hybrid plan. So the federal money will not be included in next year’s state budget – an announcement applauded by Republicans in a rare joint session of the General Assembly.
The governor says he understands the consequences of not accepting the money, even for just one year. More than 100,000 Tennesseans would be left with no way to pay for health insurance.
Hospital Survival
“A lot of us in this room have a real concern for those the Bible refers to as ‘the least of these,’” he said.
Haslam also said he is “convinced” that several struggling hospitals “will not survive this transition.”
“I know there are some [hospitals] that will be hurting. There’s no doubt about that,” says Senate Speaker Ron Ramsey. “But maybe there are some that need to be closed. I don’t know.”
The Tennessee Hospital Association has been one of the most vocal supporters of expansion. Health care facilities agreed to cuts in the federal Affordable Care Act with the assurance that they would end up with fewer patients unable to pay their doctor bills.
THA president Craig Becker says he’s “disappointed” more with the federal government for not allowing the expansion compromise than with Haslam’s decision.
Many in the legislature have been itching to pass a bill preventing the state from expanding Medicaid as envisioned by President Obama. Haslam’s decision – and a commitment to get approval from state lawmakers before moving forward – may be enough to quiet legislative attempts.
“It’s clear that he’s done his homework, and he should be commended for that,” says Rep. Jeremy Durham (R-Frankin), sponsor of a bill to block Medicaid expansion. “I just don’t want Medicaid to be expanded without the legislature’s input.”
While most Republicans are pleased, Democrats say the governor basically delivered a “no” and dressed it up “as a year of delayed action and indecision.”
“It’s a failure that will be paid with the lives of the working poor in our state,” says House Democratic Caucus Chairman Mike Turner. “This is quite simply shameful.”
Haslam’s Demands
Advocates for TennCare patients say it’s difficult to know how the governor’s plan is all that different from what exists with the program today.
Haslam wants co-pays for those who can afford to pay, something the state can already ask for under TennCare rules, according to Gordon Bonnyman of the Tennessee Justice Center.
The governor says providers should be compensated for health outcomes instead of just performing the service, a central tenant of the Affordable Care Act. And he wants a so-called “circuit-breaker” to end an expansion in case federal money is pulled from the program.
“I don‘t know what he has in mind, but by turning down the money that was already available, clearly the governor has taken on an enormous responsibility to deliver this alternative,” Bonnyman says. “We don’t know what that is yet.”
Haslam says it’s possible the state could get federal approval for the expansion compromise later this year. In that case, he says he will still ask for the okay from the legislature, requiring a special session.
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