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Tennessee Governor's Medicaid Expansion Plan Fails Again

Republican Gov. Bill Haslam's proposed Insure Tennessee plan flopped for a second time Tuesday in a Senate committee and that's thrown the House effort into confusion with two top supporters disagreeing over whether to try to move it today in a subcommittee there.

By Andy Sher

Republican Gov. Bill Haslam's proposed Insure Tennessee plan flopped for a second time Tuesday in a Senate committee and that's thrown the House effort into confusion with two top supporters disagreeing over whether to try to move it today in a subcommittee there.

Six Republican Senate Commerce Committee members voted no and only two -- including the committee's lone Democrat -- said yes on the resurrected and retooled plan to use federal Medicaid dollars under the Affordable Care Act (Obamacare). It sought to extend insurance to an estimated 280,000 Tennesseans, including nearly 19,000 in Hamilton County.

The ninth senator, physician Republican Mark Green of Clarksville, abstained, saying he had a conflict.

Hamilton County's two senators, Republicans Todd Gardenhire of Chattanooga and Bo Watson of Hixson, both voted no.

After the vote, a man shouted, "I hope you people realize how many people you sentenced to die today." Yelled a woman: "Vote 'em out."

The panel continued to work into the night on other bills and efforts to reach Gardenhire and Watson were unsuccessful. Gardenhire has stated a number of concerns with the legislation, including financial risk to the state and what he considers uncertainty over whether Tennessee can drop the two-year pilot project if it proves costly to Tennesseans. Hospitals have agreed to fund the state's share.

The resolution failed last month in the Republican-dominated Senate Health Committee on the third day of a special legislative session called by Haslam to consider what he called his "market-driven" plan. Gardenhire voted no at that time as well.

In a statement issued Tuesday night, Haslam spokesman David Smith said "the governor is disappointed in the vote but glad Insure Tennessee had a chance to be heard in two different Senate committees during regular session."

"As he has said," Smith continued, "the issue has not gone away, and he will continue to work to find a way to cover more Tennesseans and address growing health care costs in the state."

Earlier, hundreds of grassroots supporters packed the committee room and others rallied outside as the primary sponsor, Sen. Doug Overbey, R-Maryville, presented the bill.

Overbey said it had been tweaked in the Senate Health Committee to overcome objections Republicans had raised during the special session. An amendment would have delayed implementation unless the U.S. Supreme Court rules to uphold the legality of federally run health insurance exchanges also created by the Affordable Care Act. That decision is expected this summer.

It also would have required disenrollment for at least six months for anyone who didn't pay their Insure Tennessee monthly premiums. And it would have required a commitment from the federal government that the state could jettison the program at any time if costs were higher than projected. Hospitals have agreed to cover the state's share.

The federal government was to pay at least 90 percent of costs.

Overbey said state taxpayers already are paying for the federal program. Adopting Insure Tennessee would inject $1.3 billion to the state's economy, he said, and many rural hospitals risk failure without the money.

"I think if you vote no today, it ends the conversation for this year," Overbey said. "I ask you to keep the conversation going."

Whether the conversation is now ended in the House was unclear Tuesday evening. Rep. Mike Harrison, R-Harrison, chairman of the House Budget Subcommittee, had signed on to the House's version of the resolution, originally introduced by Rep. Larry Miller, D-Memphis.

Tuesday morning, Miller told reporters that Harrison had agreed to take over as primary sponsor and that Haslam had told him there were enough votes in the GOP-controlled House Insurance and Banking Subcommittee for it to pass.

Asked where the resolution stood, Harrison told the Times Free Press late Tuesday afternoon that "I just heard it failed in the Senate again. I don't see any need. I really don't see the need right now. I think it failed pretty bad. Sometimes the writing is on the wall."

That took Miller by surprise.

"Mike said he doesn't see a need to go on? Well, I think my conversation with him was that regardless of what happens in the Senate that the House would move forward. That was part of the agreement we had when I signed the bill over to him."

Advocates and Democrats despaired while Americans for Prosperity-Tennessee President Andrew Ogles, who opposed the plan, was pleased by the outcome.

"Insure Tennessee is bad for Tennessee," said Ogles, whose group aired radio ads attacking efforts to resurrect the plan. "It's nothing more than Obamacare with a pretty bow. Anyone who says it's not Obamacare is delusional. It's funded and authorized by the Affordable Care Act. It's that simple."

Senate Democratic Caucus Chairman Jeff Yarbro of Nashville, who introduced Senate Joint Resolution 93, called it "heartbreaking to see the Senate Commerce Committee fail to act on Insure Tennessee and fail to offer any alternative." He added, "Our work to provide health coverage to Tennesseans must continue.

Michele Johnson, executive director of the Tennessee Justice Center, said the vote "by a handful of senators on the Commerce Committee to block Insure Tennessee from consideration by the full Senate is a temporary triumph of politics over democracy."

Ramsey said in his own statement that "while I appreciate Gov. Haslam's hard work, it is clear that serious questions and concerns regarding Insure Tennessee remain. Insure Tennessee was carefully considered and thoroughly examined by no less than four Senate committees. Now, it is time to move on."

(c)2015 the Chattanooga Times/Free Press (Chattanooga, Tenn.)

Caroline Cournoyer is GOVERNING's senior web editor.
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