published Thursday, March 28th, 2013

Haslam rejects expanded Medicaid

Tennessee Gov. Bill Haslam could have decided Wednesday to make the sensible and humane decision to accept federal funding under the Affordable Care Act to expand Medcaid/TennCare to approximately 180,000 uninsured working-poor Tennesseans. Allowing these people, who earn between 100 percent and 138 percent of the national poverty level, access to Medicaid would not have added any new costs to the state for at least the next three years, and then the state would only have to pay a 10 percent match to keep the expansion intact.

But Gov. Haslam didn't make that decision.

Haslam punted instead for a vague middle ground that may let Tennessee receive the federal money to pay for private insurance policies for some of these spurned Tennesseans -- if he and more reasonable Republican legislators can find enough caveats to make his game to grab the money still seem like a poke in the eye against one of the core goals of Obamacare toward universal care.

The need to accept the Medicaid expansion arises from the ruling by the U.S. Supreme Court on the health care reform act. It had been written to allow a federal mandate to require states to raise the ceiling for Medicaid -- two-thirds of which is federally funded -- from 100 percent of the federal poverty level, to 138 percent. State insurance exchanges were designed to accept uninsured Americans with incomes above that level. But the high court voided the Medicaid expansion mandate, making it an option for state governments -- and leaving a hole of coverage for Americans just above the poverty level.

Haslam's decision was, of course, at least partly driven by extreme pressure from the Legislature's most myopic, callous and bitter opponents of health care reform. Left to his better senses, he might well have accepted an expanded Medicaid program, as eight more independent Republican governors have done. But with a raft of irrational Obamacare haters in the state's Legislature slinging their propagandist version the health reform act, he wilted.

His fallback position -- a tentative (and as yet unapproved) proposal to the federal Health and Human Services Department for a waiver to channel some of the Medicaid-purposed money into private insurance for the targeted population -- is not original, to be sure. Nor does it match the reach and benefits of the ACA offer.

It was initiated in Arkansas, and it's being considered by some other Republican governors despite their legislatures' opposition. These governors realize the serious personal, financial and health-care industry losses their states will suffer if they fail to accept new federal dollars for Medicaid expansion.

They aren't quite willing to sit on their hands while other states scoop up the funding to improve their residents' well-being. But they remain afraid to fully embrace the economic benefits of a healthier population and the efficiencies the ACA will drive both in Medicaid and in the insurance companies that will come into their ACA-mandated insurance exchanges next January.

Haslam's spin on his position had him excoriating Obamacare in the beginning of his announcement Wednesday, and then spouting as his own and praising potential reform efficiencies that already are embraced in the ACA playbook and among progressive insurers, like Tennessee's BlueCross BlueShield.

For example, he touted the chance under his "private insured care" option to coordinate reform efforts with health care providers to revise the standard health-care fee-for-service system in favor of "true payment reform" geared toward quality outcomes for patients. That, of course, is just one of the ACA goals aimed at creating new models of health care and best-practice procedures.

Haslam's decision and the contingent agreements on which he framed it are deeply troubling. Tennessee Hospital Association leaders and other industry experts predict that without the state's official expansion of Medicaid, health care will suffer across the state, and many hospitals, both in rural and urban areas, may be forced to close for lack of insured patients and their ability to pay for care. That's because the ACA will take some current federal funding away from hospitals in order to provide expanded Medicaid and thus more insured patients.

State business leaders and Chamber of Commerce officials, insurers and health care providers, faith groups and community advocates, have joined in warning state and legislative lawmakers of the dire consequences both to people in need of care, and to the state's health care infrastructure, over failure by the governor and Legislature to accept a federally funded expansion of Medicaid.

It's never too late to reverse gear and correct a mistake. Haslam and the Legislature shouldn't make citizens and health care in Tennessee suffer over a partisan divide. They should change course, and approve the expansion of Medicaid.

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AndrewLohr said...

And in Massachusetts, Romneycare increased the wait to see a doctor from 35 to 55 days. Go bureaucrats.

March 28, 2013 at 6:34 a.m.
EaTn said...

The right-wing politicians keep pushing the less fortunate aside, who sadly in numbers are the right-wing politicians strongest supporters.

March 28, 2013 at 7:19 a.m.
nowfedup said...

Noted the Governor is extreme right wing, but charmingly so. He nearly always "Studies" the right wing agenda, then later seems to become attracted to it, or so his history provides. Big question for all of you on health care. A. What happens to those who cannot afford it, what do they do> B, Who exactly is making what must be huge profits off healthcare, from insurance co's to final providers? Seems no one ever presents this data on other then drug companies, and the real truths, where, which elected and how much goes to buying their souls/votes?

March 28, 2013 at 10:16 a.m.
Rickaroo said...

Haslam had a choice of providing health care for the uninsured by means of a system that would have cost the state ZERO for three years and then only 10% of the cost after that. But instead he is opting to keep the system in the hands of the private insurance companies, where the expense is much, much higher and will do nothing to address the rising costs over the long haul. His stance is purely, stubbornly, obtusely ideological. So much for compassionate conservatism. And so much for common sense conservatism.

March 28, 2013 at 11:39 a.m.
Rickaroo said...

JR... houses, cars, clothes, food, bicycles, toys, brooms, and all manner of widgets in general are fine being sold on the free market. Where the health and lives of the citizens of a nation are concerned, we need a system that is fair and equitable for all, where profit is not the primary factor. Of course housing is essential to our well-being too but if someone cannot afford a $500,000 house then they can find something cheaper, or even live in section 8 housing if they are seriously poor. At least they are still able to put a roof over their heads. But when the cost of health insurance is oftentimes as much as the cost of one's mortgage, or even more, then something is seriously out of whack with our system, to put it so out of reach for the average working class person.

As for me being "functionally illiterate"...I don't put much stock in a statement like that, coming as it does from someone who is functionally insane.

March 28, 2013 at 11:55 a.m.
hixsondave said...

We all need to assume more of the responsibility for our own health care. At days end all this has to be paid for and it comes out of the taxpayers pockets. Instead of gun buy backs by the police how about a guns for health care program?

March 28, 2013 at noon
Rickaroo said...

"Your scant knowledge of how all of this comes together is scary. You don’t seem to have the slightest concept that when money is spent, it has to originate from somewhere." - JR

We are already spending (wasting) a huge amount just to keep our present broken system. Of course money will still have to be spent, but we need to focus on how we spend that money. Something that you government haters constantly fail to see is the long-term effects. You think that just because we are saving money by not spending it now, then that's a good thing and that's all that matters. But we are always going to have to spend money, as long as we still have a functioning government. It's a matter of HOW we spend the money, not WHETHER we spend it. By spending it in ways that are efficient and sensible we can save money in the long-run.

Now, I've wasted enough time with you. I have better things to do than get caught up on the merry-go-round with you whacked-out wing-nut whiners.

March 28, 2013 at 12:01 p.m.
Easy123 said...


I thoroughly enjoy watching you discredit yourself and reveal the true depths of your psychosis.

You are truly a moron.

Want proof?

"If you can't stand the heat rickyroo, get the hell out of our way."


March 28, 2013 at 12:29 p.m.
NirvanaFallacy said...

So eliminating private sector competition and going to a signal payer system where the government abolishes choice and gives all the power to bureaucrats something you liberals hope to get out of this doomed experiment called Obamacare? This thing is a disaster, it is raising premiums and bringing down the quality/availability of medical care.

There are so many better ways to fix the healthcare system without resorting to turning over control to Washington. For example, how about we allow medical insurance that just covers risks - you know the whole point of insurance - instead of covering completely predictable things like annual checkups. Here is a novel idea - allow me to pick what I want covered instead of some politician forcing the insurance companies to cover things like acupuncture, things that I don't want and likely will never get. Instead we have government mandates that are increasing the premiums I have to pay in order to cover these stupid government ideas. What's next, the government mandating car insurance policies cover oil changes and the price of gas?

Is our country really so economically illiterate that they can't understand that there is no such thing in life as a free lunch. This discussion would be funny if it weren't so sad.

"It is not from the benevolence of the butcher, the brewer, or the baker that we can expect our dinner, but from their regard to their own interest." - Adam Smith

March 28, 2013 at 5:41 p.m.
nowfedup said...

Perhaps none care to address the big question as it never seems to get asked. WHAT happens to those that cannot afford medical care. NOT one BIlL etc addresses such so while all blither about "savings" and such if cuts made etc, not one addresses what happens to those impacted. NOTE USA has 1million medical bankruptcies, 40000 die from lack of medical care in "Richest nation on earth". Er might just ask how come most of industrial nations have single payer 100% medical coverage, even Canada seems able to pull it off and despite spin from right, the citizens do not want it changed. All R's are doing is more profit for ins companies, time elected get zero medical and get is same as commoners to start with, then pass Bill that demands "Impact of Bill in detail as to who, when and how impact on citizens? Also who profits. Last question, who in final analysis pays bill for those with no insurance, a reality check.

March 29, 2013 at 12:08 p.m.
nowfedup said...

By the way would just love to have th4e "we are responsible for our own health care" post a budget for a family of two adults, two kids with joint income of say 28/Hour or 56K/year. To include HC Ins and deductible, car, home-rent-utiltiy-food-clothing-401 savings-taxes-college fund, etc. Note used 56 as that is 14/hour each, which may be a bit high in this region of low wages and no benefits. We await your economic wisdom, or put up or shut up, even stretch it to say one at 56K other at 70K or about 17/hr

March 29, 2013 at 12:14 p.m.
nowfedup said...

Ross you are a fool as you prove in every post, but never respond with facts, perhaps if you strive for GED you might advance, amusing how you try to pull off quasi intellectual, but avoid real responses. Yep sad we protect the O family, you ignorance is showing. You might seek job as refueling station for hot air ballons, you are fully qualified as fuel.

March 29, 2013 at 1:50 p.m.
NirvanaFallacy said...

I can't tell you how your family should budget their income because that is up to you as an individual, plus everyone's situation is unique.

No one denies that there is a problem with how much we are paying for health care. But what in the world makes you think it's a good idea to just eliminate competition and let Washington have total control.

How come so many people from all these countries with "single payer 100% medical coverage" come to the United States to get their treatment if it works so well? Take for example Canada, where you have to wait on average 10 weeks to get an MRI just to see what's wrong with you. Well, lots of things can go wrong in those 10 weeks - from increase in pain to just plain old death. That sound like a healthcare system that you want to be apart of?

Healthcare in other countries with single payer may very well cost less if you only count the money cost, but you fail to account for such things like the time the patient has to spend waiting or the fact the medicine/surgery they need isn't available. So yeah, its easy to bring down costs when you just refuse to pay them. So unless you believe in some type of miracle, the government cannot reduce costs without consequences and those consequences will be disastrous.

Just remember - there is no such thing in life as a free lunch.

March 29, 2013 at 3:35 p.m.
Rickaroo said...

"Just remember - there is no such thing in life as a free lunch."

"Guns don't kill people. People kill people."

"Government is not the answer to our problem. Government is the problem."

Ah, the glib, meaningless, bumper-sticker slogans of the wing-nuts! They keep slinging them at the wall, like wet noodles, hoping they'll stick.

It's true that some people from other countries come here for certain procedures but there are many Americans who also go to other countries because they are much cheaper. Also, the vast majority of Europeans and Canadians are very satisfied with their system of universal coverage and think that we Americans are insane to even be having this discussion about the pros and cons of universal health care. They are not exactly rioting in the streets demanding to have private, for-profit health care take the place of what they have. No system is going to be perfect but those other countries are obviously doing something right because they are insuring their entire populace and spending far less on it than we are. And almost every country as a whole is enjoying better overall health than America. Moreover, no one from other countries goes bankrupt or loses their home on account of medical expenses, and when they lose their jobs they still have complete health coverage.

It's funny how all the arguments being made against a single-payer system are coming from the ones who are lucky enough or rich enough to be able to have good coverage now and they are worried because they think they might have to make a few sacrifices in order that others might have some kind of coverage as well. We can and should have a single-payer system that provides at least basic coverage for everyone regardless of income level, and for those who can afford something more, then they could spend their money to get it. It is unconscionable that in the richest nation in the world, and one that likes to think of itself as civilized, so many people suffer and die prematurely on account of not being able to afford insurance to cover their health care needs.

March 29, 2013 at 4:56 p.m.
NirvanaFallacy said...

The United States provides the highest quality care in the world. You can't simply compare what other countries spend on healthcare and assume because we spend more that we then must have an inferior healthcare system. For the same reason that a Ford Focus is cheaper than a Lexus ES 350, (the Lexus is nicer and has more features), medical care in other countries is obviously going to be cheaper when they lack many things that are more readily available in the United States. You are paying attention only to prices and not to the value we receive from those prices.

Also, the phrase "there is no such things as a free lunch" is a basic economic principle that you should have learned in the first week of any high school economic class. It is not some political philosophy that you can choose to ignore or try to discount by lumping it in with what you call Wing-nut bumper sticker slogans.

March 29, 2013 at 5:46 p.m.
Rickaroo said...

"You are paying attention only to prices and not to the value we receive from those prices." - NF

When you have to be rich enough to afford those prices, the value has no meaning whatsoever for those who cannot afford it. For a family of four or for older people a good health insurance policy can cost more than a mortgage on a house. If people can't afford a Lexus they can buy a Ford Focus or even an older model used car and their ability to get around and earn a living will still not be hampered in any way. If people can't afford to shop at Saks 5th Ave. they can shop at Walmart or even Goodwill and still clothe themselves. If they can't afford to eat at Ruth's Chris Steak House, they can eat at Shoney's or grocery shop at Save-a-Lot and still feed themselves. But there is no such thing as cheap health insurance. The only alternative there is to buy a plan with an extremely high deductible, and that is not really health insurance but merely catastrophic coverage, to protect your assets. The free market is great for selling widgets and most commodities but health insurance that is vital to our individual and collective health and prosperity as a nation has no business being on the free market. All the other countries learned that a long time ago. It is only this bassackward country and neanderthals like you who think that health insurance is a privilege for the rich and the privileged and not a right for all citizens.

There is also a saying that any business person will tell you: "In order to make money you have to spend money." All the deficit hawks and austerity pushers who keep calling for reduced spending can't get it through their thick skulls that just cutting spending is no guarantee for economic growth. Quite the contrary. If we stop or drastically reduce spending for things like education, health care, job training, and infrastructure, the money we "save" in the short term will pale in comparison to the money it will cost us down the road, after those issues that should have been addressed now can no longer be put off. If we spend in the right way and in the right areas our economy will grow and the deficit will then become manageable. We are already wasting more money on our inefficient private-enterprise health care system (oh, pardon me....apparently you have great coverage so it is not inadequate for you, and that's all that matters, right?) than any other country. By focusing our spending on a system like Medicare-for-all, where the administrative costs would be far less and there would not be the issue of share holders to please or CEOs desiring to increase their profits exponentially year after year, then more people could benefit from our "highest quality of health care in the world" that presently only the rich or the lucky can benefit from.

March 29, 2013 at 7:02 p.m.
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