published Thursday, March 28th, 2013

Haslam won't expand insurance for poor

Tennessee Gov. Bill Haslam listens to a question during a news conference after speaking to a joint session of the Legislature on Wednesday in Nashville. Haslam announced that he won't pursue expanding the state's Medicaid program to help cover the uninsured as part of the federal Affordable Care Act.
Tennessee Gov. Bill Haslam listens to a question during a news conference after speaking to a joint session of the Legislature on Wednesday in Nashville. Haslam announced that he won't pursue expanding the state's Medicaid program to help cover the uninsured as part of the federal Affordable Care Act.
Photo by Associated Press /Chattanooga Times Free Press.

“I think he tried to come up with an innovative plan that would have allowed us to put more people on through a private insurance program, and he wasn’t able to get it done quickly enough through the federal government. So he decided to continue to try to work on that. ... I think he made the right decision.”

— House Majority Leader Gerald McCormick

“Gov. Haslam has said ‘no’ to federal health coverage for 300,000 uninsured working Tennesseans. He has turned down nearly $10 billion in federal funds over the next decade. ... By saying no, the governor has assumed a heavy responsibility to deliver an alternative plan that will work for all Tennesseans.”

— Michele Johnson, managing director of the Tennessee Justice Center

“We’ve long supported expanding health care coverage in Tennessee and we applaud the governor and his team for working to find credible solutions that will improve access to care. We believe all Tennesseans deserve access to affordable health care and that providers should be compensated for that care. There’s plenty of work to do on this innovative proposal.”

— Bill Gracey, president and CEO of BlueCross BlueShield of Tennessee

“We agree with him. He needs clarity, and we’re fine with that. It’s disappointing that we can’t get it probably this legislative session.”

— Tennessee Hospital Association President Craig Becker

“Gov. Haslam has worked had to develop a fiscally responsible and politically viable Tennessee Plan tailored to the unique needs of our state. We look forward to working with the governor to achieve this goal.”

— Dr. Chris Young, president-elect of the Tennessee Medical Association and Erlanger anesthesiologist

“I applaud Gov. Haslam’s decision to reject Obama’s Medicaid expansion. Without bold reform of the Medicaid program tailored to Tennessee’s unique situation, there can be no compromise on this issue. ... Tennessee must receive assurances that have not been forthcoming.” _ Republican Senate Speaker Ron Ramsey

“This is a time when the people of Tennessee need clear, precise and bold leadership, and Gov. Haslam offered none of that. It’s a failure of our moral obligation to protect the health and welfare of the most vulnerable among us. ... It’s a failure that will be paid with the lives of the working poor in our state.” _ House Democratic Caucus Chairman Mike Turner

NASHVILLE — Republican Gov. Bill Haslam is blaming the Obama administration for his Wednesday decision not to expand Tennessee's Medicaid program, saying he won't proceed unless federal officials let him implement "real health care reform."

Haslam told a joint session of the General Assembly that he sought approval of his "Tennessee Plan" but was largely unable to get clear answers from U.S. Health and Human Services officials.

His plan calls for letting the state take $1 billion or more in annual federal funds provided by the federal Affordable Care Act and, instead of putting some 181,000 people on TennCare, the state's Medicaid program, use it to help subsidize private insurance for them on a health care exchange.

Haslam told lawmakers, "I cannot recommend to you that we move forward on this [expansion] plan. Our budget amendment will not include language to accept the federal funds."

Speaking later to reporters, Haslam said that in a conversation Monday with U.S. Health and Human Services officials, "We got one or two yes's, one or two no's, and a whole lot of 'I don't knows.'"

A spokeswoman for HHS's Centers for Medicare and Medicaid Services did not respond to a Chattanooga Times Free Press request for comment.

WHAT'S NEXT

Haslam says he is interested in continuing to work with Obama administration officials to get them to agree to his "Tennessee Plan" for Medicaid expansion.

Haslam's speech left a number of Republican and Democratic lawmakers confused until he finally said he was not moving forward this session. That drew applause from relieved, majority Republicans, many of whom oppose all aspects of Obamacare.

But Democrats accused Haslam of a lack of leadership and backbone, with House Minority Leader Craig Fitzhugh, D-Ripley, questioning his sincerity, as well.

"I truly believed that the governor was going to use this opportunity to show real leadership," Fitzhugh said. "Instead we've seen more of the hand-wringing and delayed action that we've become accustomed to."

He said that, while he hopes Haslam is serious about working with the federal government to create an alternative plan, "past experience makes me question the sincerity of these efforts. All too often with this administration, we have the governor study and study and study an issue, only to come back later and say no."

After months of study, Haslam in December rejected the state creating its own health insurance exchange under the federal health overhaul. Instead, the federal government will run it.

Haslam's deputy, Claude Ramsey, said Democrats' criticisms are unfounded.

"They're wrong," he said. "They are wrong."

Republicans, meanwhile, are praising the governor.

Poll
Do you agree with Haslam's Medicaid decision?

"Without bold reform of the Medicaid program tailored to Tennessee's unique situation, there can be no compromise on this issue," Senate Speaker Ron Ramsey, R-Blountville, said.

House Majority Leader Gerald McCormick, R-Chattanooga, said Haslam "tried to come up with an innovative plan that would have allowed us to put more people on through the private insurance program, and he wasn't able to get it done quickly enough through the federal government."

He said while Haslam will continue to work on it, he has decided for now not to expand the population of Medicaid, operated in Tennessee as TennCare. McCormick said it would have been difficult to get a simple TennCare expansion through the House. Ramsey has said outright it wouldn't pass.

"I think he made the right decision," McCormick said.

The federal government is funding 100 percent of the expansion's first three years before gradually scaling its sharing down to 90 percent after 2019. Hospitals say they badly need the money from new enrollees because Washington is slashing special Medicare payments to them.

"He needs clarity, and we're fine with that," Tennessee Hospital Association President Craig Becker said. "It's disappointing that we can't get it probably this legislative session because we want to get the 100 percent federal funding for this year. ... If we lose one, it's a problem. Maybe we'll have a special session."

Haslam did not rule that out.

Erlanger Health System -- which among local health care providers stands to lose the most federal funding next year -- issued a statement saying officials are hopeful that Haslam's plan can be realized to help offset looming federal cuts elsewhere.

"Erlanger supports legislation allowing the state to move forward with coverage of more low-income Tennesseans through discussions with the Centers for Medicare and Medicaid Services," said Britt Tabor, CFO of Erlanger Health System.

The governor wants to follow the lead of governors in Arkansas and Ohio, who want to use the money to "buy" the expansion population onto the health care exchanges that also are being created under the law.

But Haslam also wants them to get the same benefits, not more as they would under Medicaid, as other people on the exchanges.

He also wants to reform the payment structure for providers where they are compensated for health outcomes and not just for services provided.

Michele Johnson with the Tennessee Justice Center, an advocacy group, said that "having turned down nearly $10 billion in federal funds over the coming years, "the governor has "assumed heavy responsibility for an alternative plan that works for all Tennesseans."

She said she hopes Haslam's intentions are "genuine, because there's a lot of Tennesseans whose lives will feel the impact of this decision. They have a duty to make it so."

Staff writers Dave Flessner and Kate Harrison contributed to this story.

about Andy Sher...

Andy Sher is a Nashville-based staff writer covering Tennessee state government and politics for the Times Free Press. A Washington correspondent from 1999-2005 for the Times Free Press, Andy previously headed up state Capitol coverage for The Chattanooga Times, worked as a state Capitol reporter for The Nashville Banner and was a contributor to The Tennessee Journal, among other publications. Andy worked for 17 years at The Chattanooga Times covering police, health care, county government, ...

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