published Saturday, March 8th, 2014

Bold action by Haslam needed for Tennesseans and their hospitols

It's time for a bold move by Gov. Bill Haslam to put the health of Tennesseans ahead of politics.

The governor announced nearly a year ago he would not seek the Affordable Care Act's Medicaid expansion, an option the Supreme Court gave the states when it ruled in 2012 on the constitutionality of what has become known as Obamacare.

Haslam said he, instead, would seek federal approval for what he call his "Tennessee Plan," which he said would be financially better for the state in the long run. However, he has never submitted a formal plan to U.S. Health and Human Services Secretary Kathleen Sebelius and suggested last month the HHS come up with a plan he can accept.

It's understandable why the governor would not seek the Medicaid expansion and its possibly untenable cost just a few years down the road when the federal government, under the law, begins to pay less and less to the states. And there's the seemingly daily changes President Obama makes to the general law. As Forrest Gump once said, "You never know what you are going to get."

But Erlanger Health Systems Chief Executive Officer Kevin Spiegel and many others believe Haslam will wait until after the November election to move forward on whatever plan he may submit or craft with the help of HHS.

"People are playing hands-off until the election," Spiegel said in an editorial board meeting with Times Free Press reporters and editors Thursday.

The thought, according to the hospital executive, is that Republicans must not show fealty toward anything that has to do with Obamacare, lest it expose a rift in the state party.

Haslam, though, has little if anything to lose. He's cruising to an almost certain re-election in November. The balance of power in the state's Congressional delegation is unlikely to change. And the makeup of the state legislature should still be firmly in GOP hands after the election.

So the governor should prioritize the "Tennessee Plan," which would allow the state to use federal funds to "buy" the Medicaid expansion population's way onto the federal health insurance exchanges in which Americans can buy coverage with subsidies based on income.

The Republican-dominated state legislature, which is in the process of passing a law to say it will have buy-in on anything Haslam does on the matter, should be prodding him -- or working with him -- to do this, although only weeks remain in this year's legislative session.

Perhaps Tennessee's plan would work somewhat like the one in Arkansas, which uses the Medicaid money to buy private insurance for about 250,000 eligible low-income residents. That state's governor, Mike Beebe, albeit a Democrat, signed the legislation on April 23, 2013, and it was approved by the federal government last September.

Other states such as Iowa and Michigan, both with Republican governors, have crafted their own plans and received federal approval. Still other states have found or are seeking waivers to go their own way with the funds.

While other deep South states such as Georgia, Alabama, Mississippi and North Carolina have flatly turned down Medicaid expansion, Haslam can and should press ahead for a plan that would assist some 180,000 low-income, mostly working adults in Tennessee.

The need is becoming critical, especially at hospitals such as Erlanger, which have had special federal funds withdrawn in the Obamacare assumption all states would expand Medicaid.

Earlier this week, hospital executives announced they were freezing paid time off for 4,000 employees from now through July, a decision Spiegel admitted was "a terrible thing we did" but one for which the alternative was laying off a quarter of its employees. He also said the hospital had taken nearly $14 million in state, federal and insurance cuts this year and was likely to see its uncompensated care rise to $92 million in 2014.

It's the perfect storm for one of Chattanooga's largest employers, which this year also has prudently phased out its traditional, defined-benefit pension plan in favor of 401(k)-like accounts, changed how its paid leave is structured and approved, and has increased what retirees pay toward their health insurance in order to right its ship.

"No one has moved faster or quicker than Erlanger has done," Spiegel said.

And yet, the hospital continues to hemorrhage red ink.

Gov. Haslam, for Erlanger -- which stands to gain some $35 million with whatever plan is crafted -- and hospitals in similar straits, for those Tennesseans you believe should have health care, don't wait to act.

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moon4kat said...

Yes, it would be nice if we had a Governor with good sense, integrity, and strength of character. So far, Haslam has been little more than a limp figure-head for the political party that favors stupidity over knowledge, and campaign contributions over research into the real impact of their primitive policies. Very disappointing that we can't do better than this.

March 8, 2014 at 11:29 a.m.
librul said...

Hey Clint - what's a hospitol?

March 8, 2014 at 11:44 a.m.
Rickaroo said...

Thank you, Mr. Editor, for airing your enlightened stance. We know you to be a conservative but you are taking the high road and setting ideology aside, as we all should on this matter. When people's lives hang in the balance it should not be a political issue. But it's obvious that Gov. Haslam is playing partisan politics based on his and other Republicans' visceral hatred of Obama.

Of all the plans for making health insurance accessible and affordable for more Americans the ACA is actually a much more conservative one than Obama might have brought to the table, and Republicans are being disingenuous to say that he refused to negotiate with them. The plan itself was a huge compromise over what he and the majority of Democrats wanted - the public option.

We are paying the price already for Haslam's obstinacy and it will only get worse if he holds out and refuses to do the right thing. It takes a special kind of mean-spirited stubbornness to keep from doing what would not only save jobs and create a bigger cash flow for the state but, more importantly, save lives and make life healthier and considerably easier for tens of thousands of Tennesseeans.

March 8, 2014 at noon
soakya said...

what a load of hogwash from you roo, but thats all you ever have. setting aside political ideology is something you, Obama or anyone on the left know anything about. everything is politics with you progressives.

March 8, 2014 at 2:22 p.m.
Rickaroo said...

I'm sorry, soakya. I will strive to be less opinionated, political, and ideological and more open-minded and reasonable like you. I'm impressed by how you remain above the fray and never let yourself be swayed by personal ideology. You and your conservative cohorts certainly dwell on a higher plane of consciousness and fairness than us biased progressives, but I for one will do my utmost to use you as a role model going forward. I am truly humbled by the magnanimity of your intellect and the depth of your wisdom. I would bow and kiss your feet if only I could, but why don't you just...kiss my ass instead. God, you're such a twit.

March 8, 2014 at 2:45 p.m.
Hunter_Bluff said...

Billy Haslam should grow a pair and face down the mindless bots in the TN legislature. Those of us who have lived in East TN know Ron Ramsey is as dumb as a shoe and unable to poor pee out of it even if we write the directions on the shoe's sole.

What would Bill tell his grandmother about this convaluted wimpy logic to wait until November to do the right thing for the most people? Where is his allegiance? To the people he swore to protect and govern or to the party and the party donors to whom he appears to care much more about?

March 9, 2014 at 9:40 a.m.
Plato said...

Your editorial makes some good points but you have a bad case of Republican fuzzy math. You state:

"It's understandable why the governor would not seek the Medicaid expansion and its possibly untenable cost just a few years down the road when the federal government, under the law, begins to pay less and less to the states."

The fact is CBO estimates show that the federal government will bear nearly 93 percent of the costs of the Medicaid expansion over its first nine years (2014-2022). The federal government will pick up 100 percent of the cost of covering people made newly eligible for Medicaid for the first three years (2014-2016) and no less than 90 percent on a permanent basis.

But the most egregious oversight of your piece is the fact that you are simply ignoring the fact that the $92 in uncompensated care by Erlanger alone will be passed on to those of us that pay for our insurance including businesses that pay for their employees insurance or a portion of it. When you add up the cost of uncompensated care for all the hospitals in the state you come up with an astronomical number, much off which would be offset if the Governor would only take the money from the Federal Government that Tennessee tax payers have been sending in.

You don't have to be a mathematician to realize that the cost of NOT taking the federal funds our state is entitled to under Obama Care is much greater than the 10% max portion of the bill that the state will have to pick up, so your "untenable cost" argument is obviously without merit.

March 9, 2014 at 11:35 a.m.
Rickaroo said...

You make a good point, Plato. I was so bowled over by the fact that this conservative editor had anything positive to say about Obamacare that I did not think to remark on that part of his article, which indeed bears criticism. In fact, I believe that I was actually hasty in my praise of Mr. Cooper's article. It seems that he was not really pushing for implementation of Obamacare, or even that part of it which would allow Medicaid expansion, as he was for Haslam's pro-actively going forward with his "Tennessee Plan," whatever the heck that is.

March 9, 2014 at 12:32 p.m.
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