Tennessee Convenes Special Session on Medicaid Expansion
By Andy Sher
Gov. Bill Haslam urged skeptical state Republican lawmakers Monday night to set aside the "easy political argument" against his Insure Tennessee proposal and embrace it as conservatives' opportunity to improve people's lives while attacking soaring health care costs.
"This is not Obamacare," the Republican governor said as he addressed the GOP-dominated General Assembly on the first day of a week-long special session on the issue.
Haslam is seeking approval for what he calls his "market-driven" plan to use federal Medicaid dollars to extend health insurance coverage to 280,000 low-income Tennesseans with a two-year pilot project.
The federal government would provide $2.8 billion over the two-year period. Tennessee hospitals have agreed to fund the state share -- estimated at $74 million -- with an increase in the existing voluntary assessment on their net revenues.
During his 15-minute speech, the governor acknowledged "that for many, the easiest thing is to say: 'This is Obamacare, and I want nothing to do with it.'"
But he asked they "look past the easy political argument and do what Tennesseans have always done -- come up with a plan that addresses Tennesseans' needs and do it in a fiscally responsible way.
"Like many of you, I didn't come to state government just to make a point. I came to make a difference," he told the politicians gathered on Monday.
The governor also sought to knock down critics' attacks. He re-emphasized that under any agreement with President Barack Obama's administration, the state will be able to walk away at any time if the federal government decreases its 90 percent share of funding or hospitals balk at further funding.
Haslam is asking state lawmakers to approve a resolution granting him authority to seek a federal waiver of Medicaid rules to implement the program. Conservative critics have pounced and many Republicans in the GOP-dominated House and Senate are spooked by anything to do with the president and his Affordable Care Act.
The governor is seeking to join 10 other states where Republicans initiated Medicaid expansions as envisioned in the 2010 federal law. The decision on whether to expand the Medicaid health care program for the poor was left up to states as a result of the 2012 U.S. Supreme Court ruling that upheld the basic law. The ruling did away with a mandatory requirement that states expand health care.
Haslam says his Insure Tennessee proposal is a two-pronged, "market-driven" project he says should appeal to Republicans. It would provide vouchers to low-income workers who could use them to join their employers' health insurance programs.
Others would go into a separate category where they would pay modest premiums and co-pays with incentives for healthy behaviors like avoiding use of expensive hospital emergency rooms for non-emergency care.
"Insure Tennessee introduces personal responsibility and patient engagement through choice, incentives and co-pays in a way that doesn't happen with Medicaid," Haslam told lawmakers.
House Majority Leader Gerald McCormick, R-Chattanooga, who is carrying the governor's resolution, called it a "good speech" and said the governor "brought the human element into it, which was good. He spoke from the heart."
"We'll see whether it affects the votes," McCormick added. "Hopefully we'll know in the next couple of days."
House Republican Caucus Chairman Glen Casada, of Franklin, who opposes the plan, said that "easily the majority of [Republican] members at best are doubtful. They're not sure if this is good for Tennessee on a long-time base. So the governor's got his work cut out for him. He'll have to convince 50 out of 99."
Republicans have 73 members in the GOP-run House. Almost all the 26 Democrats, except for one or possibly two, expect to vote for the plan, leaders say. So the governor needs 24 Republicans to reach 50.
The 33-member Senate may be a tougher road. The chamber has 28 Republicans and just five Democrats. The resolution will need 17 votes there.
House and Senate committees are expected to begin working on the resolution today. Anyone could block the resolution.
Senate Commerce Committee Chairman Jack Johnson, R-Franklin, will hold a hearing on the plan today.
"What I'm hearing from my constituents is they're just tired of being beholden to the federal government," Johnson said. "I know the governor worked very hard to negotiate a deal that would be more palatable with a lot more flexibility than a traditional Medicaid expansion, but even with that there are a lot of questions about the federal government honoring that commitment."
During his speech, Haslam related how at an annual National Governors Association meeting in Washington, one Republican governor asked Obama why he didn't make Medicaid a block-grant program and free them from rules. He said Obama told them, "Because I don't trust you to take care of the least of these."
Haslam said he told Obama that "with all due respect," he and the other GOP governors ran "so that we can take care of the least of these. I think it's one of our most solemn obligations of government."
The governor then told lawmakers "this is also an issue about who we are. My faith doesn't allow me to walk on the other side of the road and ignore a need that can be met. Particularly in this case, when the need is Tennesseans who have life-threatening situations without access to health care.
"Particularly," Haslam added, "when the need can be met like this one can, without cost to our state, with money that our state is currently being taxed for and is sent elsewhere, and with a plan that can help answer one our nation's biggest issues."
(c)2015 the Chattanooga Times/Free Press (Chattanooga, Tenn.)